Provider Demographics
NPI:1790261592
Name:RICHARD, MIRLINE (RN)
Entity Type:Individual
Prefix:
First Name:MIRLINE
Middle Name:
Last Name:RICHARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MIRLINE
Other - Middle Name:
Other - Last Name:OMEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MIRLINE OMEGA RN
Mailing Address - Street 1:5205 VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-7907
Mailing Address - Country:US
Mailing Address - Phone:786-269-1409
Mailing Address - Fax:954-208-0680
Practice Address - Street 1:5205 VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-7907
Practice Address - Country:US
Practice Address - Phone:786-269-1409
Practice Address - Fax:954-208-0680
Is Sole Proprietor?:No
Enumeration Date:2018-07-14
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X, 376J00000X, 376K00000X, 374U00000X, 376J00000X, 376K00000X
FLRN9434377163WH0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health