Provider Demographics
NPI:1225541436
Name:AMIRZAVEH-ASL, PARIVASH
Entity Type:Individual
Prefix:
First Name:PARIVASH
Middle Name:
Last Name:AMIRZAVEH-ASL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3488 VELDA DAIRY DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-2171
Mailing Address - Country:US
Mailing Address - Phone:850-591-7272
Mailing Address - Fax:
Practice Address - Street 1:3488 VELDA DAIRY DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-2171
Practice Address - Country:US
Practice Address - Phone:850-591-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3085872163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse