Provider Demographics
NPI:1871228585
Name:DURENA, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:DURENA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 N 73RD TER
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-7138
Mailing Address - Country:US
Mailing Address - Phone:786-803-2984
Mailing Address - Fax:
Practice Address - Street 1:740 N 73RD TER
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-7138
Practice Address - Country:US
Practice Address - Phone:786-803-2984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9538797163WH0200X, 163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WH0200XNursing Service ProvidersRegistered NurseHome Health