MEDICARE: DEWHURST MEDICALSERVICES, INC.

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	363L00000X	Nurse Practitioner	ARNP3124292	FL

General Provider Information

NPI Number	:	1528257276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEWHURST MEDICALSERVICES, INC.

Provider Business Mailing Address
First Line	:	1127 MERIDIAN AVE
Second Line	:	#7
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-4545
Country	:	US
Telephone Number	:	786-573-3397
Fax Number	:	786-573-2367

Provider Business Practice Location Address
First Line	:	1127 MERIDIAN AVE
Second Line	:	#7
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-4545
Country	:	US
Telephone Number	:	786-573-3397
Fax Number	:	786-573-2367

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TYLER T DEWHURST
Credential	:	ARNP
Telephone Number	:	786-573-3397

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	10/18/2007

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