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General NPI Number Information
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NPI Number | 1497251128
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Entity Type | Individual
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Provider Name | MILDRED ELIZ BODE ARNP
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Gender | Female
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 04/02/2018
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Provider Practice Location Address
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Address Line | 19711 NW 84TH AVE
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City | HIALEAH
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State | FL
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Zip | 33015-5974
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Country | US
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Telephone | 305-613-0545
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Fax |
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Provider Business Mailing Address
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Address Line | 19711 NW 84TH AVE
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City | HIALEAH
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State | FL
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Zip | 33015-5974
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Country | US
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Telephone | 305-613-0545
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9209210
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License Number State | FL
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