1710335310 NPI number — MASON HERSHORIN MSN ARNP INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710335310 NPI number — MASON HERSHORIN MSN ARNP INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASON HERSHORIN MSN ARNP INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEDICAL PRACTITIONER HEALTHSYSTEMS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710335310
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4217 SW 64TH AVE
Provider Second Line Business Mailing Address:
SUITE #1
Provider Business Mailing Address City Name:
DAVIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33314-3446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-432-1812
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4217 SW 64TH AVE
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
DAVIE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33314-3446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-432-1812
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2016

Additional Information

Authorized Official

Authorized Official Last Name:
NIETO
Authorized Official First Name:
NICOLAS
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL ASSISTANT
Authorized Official Telephone Number:
954-432-1812

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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