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General NPI Number Information
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NPI Number | 1629698121
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Entity Type | Organization
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Legal Business Name | AMAVIE WELLNESS CENTER LLC
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Dates
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Enumeration Date | 04/24/2020
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | 1492 NW 153RD AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-2453
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Country | US
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Telephone | 786-285-9682
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Fax |
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Provider Business Mailing Address
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Address Line | 1492 NW 153RD AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-2453
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Country | US
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Telephone | 786-285-9682
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NAHOMIE MIRVILLE
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Credential | DNP,AAPRN,FNP-BC
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Telephone | 786-285-9682
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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