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General NPI Number Information
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NPI Number | 1558858332
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Entity Type | Individual
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Provider Name | MYRTHENE NICOLAS APRN
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Gender | Female
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Dates
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Enumeration Date | 04/17/2018
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Last Update Date | 11/08/2022
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Provider Practice Location Address
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Address Line | 220 SIERRA DR
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City | MIAMI
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State | FL
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Zip | 33179-3855
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Country | US
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Telephone | 305-653-8427
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Fax |
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Provider Business Mailing Address
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Address Line | 220 SW 192ND TER
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-5454
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Country | US
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Telephone | 786-440-9775
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | APRN9259903
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License Number State | FL
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