Provider Demographics
NPI:1407365364
Name:BRICE, HILAIR
Entity Type:Individual
Prefix:MR
First Name:HILAIR
Middle Name:
Last Name:BRICE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:HILAIRE
Other - Middle Name:
Other - Last Name:BRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2250 BALSAN WAY
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6434
Mailing Address - Country:US
Mailing Address - Phone:561-358-3669
Mailing Address - Fax:
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-5495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9243371163WP0808X, 163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health