Provider Demographics
NPI:1295189140
Name:TITE FAMILY PRACTICE AND SKIN CARE CLINIC
Entity Type:Organization
Organization Name:TITE FAMILY PRACTICE AND SKIN CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ENRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:305-501-2804
Mailing Address - Street 1:2441 NW 7 ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125
Mailing Address - Country:US
Mailing Address - Phone:305-501-2804
Mailing Address - Fax:786-590-1080
Practice Address - Street 1:2441 NW 7 ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125
Practice Address - Country:US
Practice Address - Phone:305-501-2804
Practice Address - Fax:786-590-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9227025364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty