Provider Demographics
NPI:1447606157
Name:BERMUDEZ, JOSE (NP)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:BERMUDEZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5063 SW 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5068
Mailing Address - Country:US
Mailing Address - Phone:786-553-4188
Mailing Address - Fax:
Practice Address - Street 1:6445 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4813
Practice Address - Country:US
Practice Address - Phone:305-448-8557
Practice Address - Fax:305-448-8570
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9227122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily