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General NPI Number Information
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NPI Number | 1871245704
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Entity Type | Organization
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Legal Business Name | COSMETICARE RECOVERY LLC
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Dates
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Enumeration Date | 01/21/2022
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 1950 NE 6TH ST UNIT 1593
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City | POMPANO BEACH
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State | FL
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Zip | 33060-6541
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Country | US
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Telephone | 786-708-2404
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Fax |
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Provider Business Mailing Address
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Address Line | 801 BRINY AVE APT 1403
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City | POMPANO BEACH
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State | FL
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Zip | 33062-6332
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Country | US
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Telephone | 954-254-6662
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR/OWNER
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Name | MS. TAMEIKA MIRABELLI
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Credential | APRN
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Telephone | 954-254-6662
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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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