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General NPI Number Information
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NPI Number | 1750242400
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Entity Type | Organization
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Legal Business Name | GRACECARE AND WELLNESS TELEMEDICINE
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Dates
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Enumeration Date | 11/21/2025
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 8358 W OAKLAND PARK BLVD STE 103
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City | SUNRISE
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State | FL
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Zip | 33351-7340
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Country | US
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Telephone | 305-333-5938
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Fax |
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Provider Business Mailing Address
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Address Line | 8358 W OAKLAND PARK BLVD STE 103
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City | SUNRISE
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State | FL
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Zip | 33351-7340
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Country | US
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Telephone | 305-333-5938
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MYRLENE MIOT-DESMORNES
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Credential |
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Telephone | 305-333-5938
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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