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General NPI Number Information
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NPI Number | 1619350832
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Entity Type | Organization
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Legal Business Name | QUALIFIED HEALTH SOLUTION LLC
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 179 SE 36TH AVE
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City | HOMESTEAD
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State | FL
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Zip | 33033-5949
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Country | US
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Telephone | 305-699-3204
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Fax |
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Provider Business Mailing Address
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Address Line | 179 SE 36TH AVE
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City | HOMESTEAD
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State | FL
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Zip | 33033-5949
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Country | US
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Telephone | 305-699-3204
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. NICOLE M FIELDS
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Credential | DO
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Telephone | 305-699-3204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | OS11204
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License Number State | FL
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