Individual
GWENVANETTE CROMARTIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3730 NW 195TH ST, MIAMI GARDENS, FL 33055-1938
(305) 621-6324
(305) 474-0969
Mailing address
3730 NW 195TH ST, MIAMI GARDENS, FL 33055-1938
(305) 621-6324
(305) 474-8566
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
11-88-GH
FL
253Z00000X
In Home Supportive Care Agency
11-431-GH
FL
253Z00000X
In Home Supportive Care Agency
Primary
11-88-GH
FL
253Z00000X
In Home Supportive Care Agency
5113-5-GA
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
681582196
—
FL
Enumeration date
01/24/2022
Last updated
01/24/2022
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