Provider Demographics
NPI:1598373300
Name:PICKETT, DINAH
Entity Type:Individual
Prefix:
First Name:DINAH
Middle Name:
Last Name:PICKETT
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 1:2640 HOLLYWOOD BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4830
Mailing Address - Country:US
Mailing Address - Phone:954-505-7957
Mailing Address - Fax:954-744-7408
Practice Address - Street 1:2640 HOLLYWOOD BLVD STE 101
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4830
Practice Address - Country:US
Practice Address - Phone:954-505-7957
Practice Address - Fax:954-744-7408
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994233253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP230-170-61-509-0OtherHOME CARE