Provider Demographics
NPI:1437865300
Name:MINVIEL, MIRDINE EMMELINE
Entity Type:Individual
Prefix:
First Name:MIRDINE
Middle Name:EMMELINE
Last Name:MINVIEL
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 1:4787 NW 72ND PL
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2741
Mailing Address - Country:US
Mailing Address - Phone:954-822-9322
Mailing Address - Fax:
Practice Address - Street 1:4787 NW 72ND PL
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-2741
Practice Address - Country:US
Practice Address - Phone:954-822-9322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023977363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily