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General NPI Number Information
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NPI Number | 1639477789
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Entity Type | Organization
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Legal Business Name | JACKSON HEALTH SYSTEM
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Dates
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Enumeration Date | 03/14/2011
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Last Update Date | 03/14/2011
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Provider Practice Location Address
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Address Line | 16455 NE 6TH AVE
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City | MIAMI
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State | FL
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Zip | 33162-3675
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Country | US
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Telephone | 786-955-6089
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Fax | 786-955-6091
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Provider Business Mailing Address
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Address Line | 2034 NW 145TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-2864
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Country | US
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Telephone | 305-585-1140
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Fax | 305-585-0031
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Authorized Official
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Title or Position | FNP-BC, NP-C
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Name | MS. CLARE MAY PEREIRA
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Credential | ARNP
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Telephone | 954-632-9578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1896652
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License Number State | FL
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