Provider Demographics
NPI:1962139162
Name:ISMORIN, NAHOMIE
Entity type:Individual
Prefix:
First Name:NAHOMIE
Middle Name:
Last Name:ISMORIN
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 1:2091 SW 152ND TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4373
Mailing Address - Country:US
Mailing Address - Phone:786-530-7819
Mailing Address - Fax:
Practice Address - Street 1:2091 SW 152ND TER
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4373
Practice Address - Country:US
Practice Address - Phone:786-530-7819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11020633363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty