Provider Demographics
NPI:1194120642
Name:MIOT-DESMORNES, MYRLENE
Entity type:Individual
Prefix:
First Name:MYRLENE
Middle Name:
Last Name:MIOT-DESMORNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20451 NW 2ND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2539
Mailing Address - Country:US
Mailing Address - Phone:786-520-4064
Mailing Address - Fax:305-290-8603
Practice Address - Street 1:20451 NW 2ND AVE STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-2539
Practice Address - Country:US
Practice Address - Phone:786-520-4064
Practice Address - Fax:305-290-8603
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9225787363LF0000X
FLAPRN9225787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty