Provider Demographics
NPI:1356674907
Name:ZEPHIRIN, MIMOSE (RN)
Entity Type:Individual
Prefix:
First Name:MIMOSE
Middle Name:
Last Name:ZEPHIRIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10038 SW 166TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1036
Mailing Address - Country:US
Mailing Address - Phone:305-383-5655
Mailing Address - Fax:305-383-5655
Practice Address - Street 1:10038 SW 166TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1036
Practice Address - Country:US
Practice Address - Phone:305-383-5655
Practice Address - Fax:305-383-5655
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9185127163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse