=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699952747
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIMI FERRER-CRUZ ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2008
-----------------------------------------------------
Last Update Date | 04/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9220 SUNSET DR STE 205
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-3259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-271-1988
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7401 SW 125TH CT
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33183-3500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-279-7155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 9206260
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------