Provider Demographics
NPI:1609063544
Name:GARCON, JOSE NADINE
Entity Type:Individual
Prefix:
First Name:JOSE NADINE
Middle Name:
Last Name:GARCON
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 1:1133 SW 167TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1422
Mailing Address - Country:US
Mailing Address - Phone:305-724-8040
Mailing Address - Fax:954-435-5982
Practice Address - Street 1:2501 S PALM AVE STE 1-212
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-5091
Practice Address - Country:US
Practice Address - Phone:954-404-7052
Practice Address - Fax:954-435-5982
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7571103TC0700X
FLPY7571103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical