Provider Demographics
NPI:1508120973
Name:JLM NURSE PRACTITIONERS LLC
Entity Type:Organization
Organization Name:JLM NURSE PRACTITIONERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-822-4107
Mailing Address - Street 1:2140 W 68TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1815
Mailing Address - Country:US
Mailing Address - Phone:305-822-4107
Mailing Address - Fax:786-497-2989
Practice Address - Street 1:2140 W 68TH ST
Practice Address - Street 2:SUITE 305
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1815
Practice Address - Country:US
Practice Address - Phone:305-822-4107
Practice Address - Fax:786-497-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065252207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty