Provider Demographics
NPI:1053842336
Name:MUDARESI, SEMKO (RNFA)
Entity Type:Individual
Prefix:
First Name:SEMKO
Middle Name:
Last Name:MUDARESI
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5421
Mailing Address - Country:US
Mailing Address - Phone:954-987-2000
Mailing Address - Fax:
Practice Address - Street 1:2900 CORPORATE WAY
Practice Address - Street 2:DOOR D
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-3925
Practice Address - Country:US
Practice Address - Phone:954-276-5685
Practice Address - Fax:954-985-7074
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9199264163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical