MEDICARE: MS. KAMILAH CUMMINGS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC1500X	Community Health Registered Nurse	9432404	FL
2	163W00000X	Registered Nurse	9432404	FL

General Provider Information

NPI Number	:	1023604378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAMILAH CUMMINGS

Provider Business Mailing Address
First Line	:	2029 NW 87TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33147-4233
Country	:	US
Telephone Number	:	786-469-0677
Fax Number	:

Provider Business Practice Location Address
First Line	:	8652 NW 22ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33147-4173
Country	:	US
Telephone Number	:	305-705-6077
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2020
Last Update Date	:	12/20/2020

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