Providence Community Center LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

3078052 Issued in FL

Legal business name

PROVIDENCE COMMUNITY CENTER LLC

Practice address

5932 NE 2ND Ave
Miami, FL 33137-2010

Phone

(786) 546-5129

Fax

(954) 241-6117

NPI assigned

Aug 11, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Julina T Dorval, ARNPNPI 1386918217

Title

Managing Member

Phone

(786) 546-5129

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Julina Tillus Dorval, ARNP

  • Primary Care Clinic/Center
  • Miami Shores, FL
  • NPI 1386918217

  Family

  Medicare reassignment NPD Authorized official
• Alphonse Giloux Dufreny, MD

  • General Practice Physician
  • Margate, FL
  • NPI 1356311922
  Medicare reassignment NPD
• Saul Ernest, ARNP, NP-C

  • Nurse Practitioner
  • Miramar, FL
  • NPI 1174975684

  Family

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407715200000",
    "number": "1457760712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5932 NE 2ND AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331372010",
            "telephone_number": "786-546-5129",
            "fax_number": "954-241-6117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5932 NE 2ND AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331372010",
            "telephone_number": "786-546-5129",
            "fax_number": "954-241-6117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE COMMUNITY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-11",
        "last_updated": "2014-08-11",
        "status": "A",
        "authorized_official_last_name": "DORVAL",
        "authorized_official_first_name": "JULINA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "786-546-5129",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME94972",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "3078052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Lawrence Proulx, RN, MSN, ARNP
• Ismara Yanet Provance Rojas
• Provectus Health LLC
• Provena Care LLC
• Provena Medequip LLC
• Providence Healthcare
• Providence Healthcare Services, Inc.
• Providence Healthcare Services, Inc.
• Providence Homecare LLC
• Providence Homecare LLC

• Family Nurse Practitioner in Miami, FL
• Providers in Miami, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.