Provider Demographics
NPI:1336730951
Name:HEART 623 HEART
Entity Type:Organization
Organization Name:HEART 623 HEART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:MS
Authorized Official - First Name:EDLYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-480-3072
Mailing Address - Street 1:4846 N UNIVERSITY DR STE 612
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33351-4510
Mailing Address - Country:US
Mailing Address - Phone:954-480-3072
Mailing Address - Fax:
Practice Address - Street 1:4846 N UNIVERSITY DR STE 612
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351-4510
Practice Address - Country:US
Practice Address - Phone:954-480-3072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty