Individual
HEREWARD PENNYCOOKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3489 NW 24TH ST, LAUDERDALE LAKES, FL 33311-2610
(954) 822-3092
Mailing address
3489 NW 24TH ST, LAUDERDALE LAKES, FL 33311-2610
(954) 822-3092
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
11754900
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3747A0650X
—
FL
Enumeration date
01/06/2022
Last updated
01/06/2022
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