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NPI Code Detail

MEDICARE: NINA DE JESUS PHARMD

MEDICARE: NINA DE JESUS PHARMD
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
1183500000XPharmacistPS58126FL

General Provider Information

NPI Number : 1063993863
Entity Type Code : Individual
Provider Name (Legal Business Name) : NINA DE JESUS PHARMD
Provider Business Mailing Address
First Line : 6992 SW 39TH ST APT I201
Second Line :
City : DAVIE
State : FL
Zip : 33314-2458
Country : US
Telephone Number : 787-413-2818
Fax Number :
Provider Business Practice Location Address
First Line : 12425 HAGEN RANCH RD
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33437-4107
Country : US
Telephone Number : 305-652-2411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2018
Last Update Date : 08/28/2018

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Directions to “ NINA DE JESUS PHARMD” Practice Location

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