Individual
MS. TALLY HUSTACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1601 NW 12TH AVE, BOX 016960 M851, MIAMI, FL 33101-6960
(305) 243-4029
(305) 243-8470
Mailing address
1601 NW 12TH AVE, BOX 016960 M851, MIAMI, FL 33101-6960
(305) 243-4029
(305) 243-8470
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
ARNP3067572
FL
163WP0200X
Pediatric Registered Nurse
Primary
ARNP3067572
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3059677-00
—
FL
Enumeration date
06/29/2006
Last updated
01/20/2012
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