Provider Demographics
NPI:1497251128
Name:BODE, MILDRED ELIZ (ARNP)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:ELIZ
Last Name:BODE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19711 NW 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5974
Mailing Address - Country:US
Mailing Address - Phone:305-613-0545
Mailing Address - Fax:
Practice Address - Street 1:19711 NW 84TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5974
Practice Address - Country:US
Practice Address - Phone:305-613-0545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9209210363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily