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General NPI Number Information
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NPI Number | 1962828103
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Entity Type | Organization
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Legal Business Name | HEAVENLY HEALTH SERVICES LLC
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Dates
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Enumeration Date | 03/12/2014
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Last Update Date | 08/29/2014
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Provider Practice Location Address
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Address Line | 388 SW 163RD AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1084
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Country | US
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Telephone | 954-673-4065
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Fax |
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Provider Business Mailing Address
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Address Line | 388 SW 163RD AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1084
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Country | US
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Telephone | 954-673-4065
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Fax |
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Authorized Official
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Title or Position | PROPRIATOR
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Name | MRS. EVA MIREILLE JACQUES
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Credential | ARNP
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Telephone | 954-673-4065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 3082172
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License Number State | FL
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