Individual
JACK WILLIAMS PEREZ MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
5991 SW 76TH ST APT A4, SOUTH MIAMI, FL 33143-5130
(786) 587-8479
Mailing address
8877 SW 25TH ST, MIAMI, FL 33165-2018
(786) 587-8479
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
RN9638337
FL
376G00000X
Nursing Home Administrator
RN9638337
FL
Other
Enumeration date
02/01/2024
Last updated
02/01/2024
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