Provider Demographics
NPI:1265894653
Name:SERVALIS, VENANTE ISME (ARNP)
Entity type:Individual
Prefix:DR
First Name:VENANTE
Middle Name:ISME
Last Name:SERVALIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5070 SW 163RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4953
Mailing Address - Country:US
Mailing Address - Phone:954-383-2824
Mailing Address - Fax:
Practice Address - Street 1:7900 NW 27TH AVE STE D10
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147
Practice Address - Country:US
Practice Address - Phone:305-403-4003
Practice Address - Fax:305-403-4006
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9198815363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily