MEDICARE: MR. HERBERT GOLDWIRE ARNP

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	363LP2300X	Primary Care Nurse Practitioner	ARNP9207809	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN9207809	FL

General Provider Information

NPI Number	:	1669772406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HERBERT GOLDWIRE ARNP

Provider Business Mailing Address
First Line	:	11216 NW 7TH ST
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-7957
Country	:	US
Telephone Number	:	954-681-2881
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 MADRUGA AVE STE 406
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-3019
Country	:	US
Telephone Number	:	954-681-2881
Fax Number	:	305-740-8103

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

Provider Enumeration Date	:	10/27/2010
Last Update Date	:	06/08/2021

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