Provider Demographics
NPI:1043232630
Name:SERRECCHIA, DOLORES SELENA (BSN)
Entity Type:Individual
Prefix:MS
First Name:DOLORES
Middle Name:SELENA
Last Name:SERRECCHIA
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 NW 193RD AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3221
Mailing Address - Country:US
Mailing Address - Phone:305-547-2500
Mailing Address - Fax:305-547-2673
Practice Address - Street 1:1477 NW 8TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1425
Practice Address - Country:US
Practice Address - Phone:305-547-2500
Practice Address - Fax:305-547-2673
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1955832163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics