Basic Information
| Provider Information | |||||||||
| NPI: | 1609128412 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLE | ||||||||
| FirstName: | DEENA | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9351 NW 14TH CT | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330242418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542949262 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10261 PINES BLVD | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330266008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543562878 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3747P1801X | N | Nursing Service Related Providers | Technician | Personal Care Attendant | 106S00000X | FL | Y |
No ID Information.