Provider Demographics
NPI:1083335871
Name:JOSEPH, MIMOSE (CNA)
Entity Type:Individual
Prefix:
First Name:MIMOSE
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13270 SW 256TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6821
Mailing Address - Country:US
Mailing Address - Phone:786-348-8491
Mailing Address - Fax:
Practice Address - Street 1:13270 SW 256TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-6821
Practice Address - Country:US
Practice Address - Phone:786-348-8491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA40738374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCNA40738OtherNURSING ASSISTANT CERTIFICATION