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General NPI Number Information
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NPI Number | 1265184956
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Entity Type | Individual
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Provider Name | GWENVANETTE CROMARTIE
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Gender | Female
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 3730 NW 195TH ST
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City | MIAMI GARDENS
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State | FL
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Zip | 33055-1938
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Country | US
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Telephone | 305-621-6324
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Fax | 305-474-0969
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Provider Business Mailing Address
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Address Line | 3730 NW 195TH ST
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City | MIAMI GARDENS
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State | FL
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Zip | 33055-1938
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Country | US
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Telephone | 305-621-6324
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Fax | 305-474-8566
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 11-88-GH
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 11-431-GH
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 5113-5-GA
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 11-88-GH
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License Number State | FL
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