Provider Demographics
NPI:1225275639
Name:JACKSON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:JACKSON MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:PAULINE
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:786-466-8381
Mailing Address - Street 1:16823 NW 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-4024
Mailing Address - Country:US
Mailing Address - Phone:786-466-8381
Mailing Address - Fax:305-381-6165
Practice Address - Street 1:169 E FLAGLER ST FL 11
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-1210
Practice Address - Country:US
Practice Address - Phone:786-466-8381
Practice Address - Fax:305-381-6165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1145932282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital