Provider Demographics
NPI:1568889947
Name:PASCALE KIDANE, ARNP, P.L.L.C
Entity Type:Organization
Organization Name:PASCALE KIDANE, ARNP, P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PASCALE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIDANE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-336-0687
Mailing Address - Street 1:610 8TH ST
Mailing Address - Street 2:APT 101
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-6118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7392 NW 35TH TER
Practice Address - Street 2:SUITE 305
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1271
Practice Address - Country:US
Practice Address - Phone:305-858-2666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9178816363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty