Provider Demographics
NPI:1629561873
Name:CORDOVI, HANIET (MD)
Entity Type:Individual
Prefix:
First Name:HANIET
Middle Name:
Last Name:CORDOVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 NE 25TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-6215
Mailing Address - Country:US
Mailing Address - Phone:305-951-9823
Mailing Address - Fax:
Practice Address - Street 1:600 NE 22ND TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-4707
Practice Address - Country:US
Practice Address - Phone:786-668-3342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9257883163W00000X
PR19977208D00000X
FLACN1078208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No163W00000XNursing Service ProvidersRegistered Nurse