Provider Demographics
NPI:1871245704
Name:COSMETICARE RECOVERY LLC
Entity Type:Organization
Organization Name:COSMETICARE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMEIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRABELLI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:954-254-6662
Mailing Address - Street 1:801 BRINY AVE APT 1403
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-6332
Mailing Address - Country:US
Mailing Address - Phone:954-254-6662
Mailing Address - Fax:
Practice Address - Street 1:1950 NE 6TH ST UNIT 1593
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6541
Practice Address - Country:US
Practice Address - Phone:786-708-2404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty