Provider Demographics
NPI:1700135928
Name:NAZARE MEDICAL CENTER, CORP
Entity Type:Organization
Organization Name:NAZARE MEDICAL CENTER, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAILY
Authorized Official - Middle Name:V
Authorized Official - Last Name:YBARGOLLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-123-4567
Mailing Address - Street 1:55 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5739
Mailing Address - Country:US
Mailing Address - Phone:786-332-4931
Mailing Address - Fax:786-334-6403
Practice Address - Street 1:55 W 29TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5739
Practice Address - Country:US
Practice Address - Phone:786-332-4931
Practice Address - Fax:786-334-6403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9214684363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty