Provider Demographics
NPI:1710335310
Name:MASON HERSHORIN MSN ARNP INC.
Entity Type:Organization
Organization Name:MASON HERSHORIN MSN ARNP INC.
Other - Org Name:MEDICAL PRACTITIONER HEALTHSYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:NIETO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:954-432-1812
Mailing Address - Street 1:4217 SW 64TH AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-3446
Mailing Address - Country:US
Mailing Address - Phone:954-432-1812
Mailing Address - Fax:
Practice Address - Street 1:4217 SW 64TH AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3446
Practice Address - Country:US
Practice Address - Phone:954-432-1812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty