MEDICARE: WANDA NITISS

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	374U00000X	Home Health Aide
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1740825637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANDA NITISS

Provider Business Mailing Address
First Line	:	10300 SW 72ND ST STE 187
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3040
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10300 SW 72ND ST STE 187
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3040
Country	:	US
Telephone Number	:	786-630-8771
Fax Number	:

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

Provider Enumeration Date	:	11/14/2019
Last Update Date	:	11/14/2019

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Directions to “ WANDA NITISS ” Practice Location

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