Active NPI
Eric Innocent
- Physician Assistant
- Miramar, FL
National Provider Identifier
1497473896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 10296
- Practice address
- 9096 SW 36TH MNR
Miramar, FL 33025-7964 - Phone
- (786) 320-3048
- NPI assigned
- Aug 22, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1365-P.A. | PR | |
| Physician Assistant | 363A00000X | 10296 | AZ | Primary |
Addresses
Primary practice location
9096 SW 36TH MNR
Miramar, FL 33025-7964
Mailing address
4703 S Mill Ave
Tempe, AZ 85282-6721
Phone (786) 320-3048
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10296 | AZ | MD | Physician Assistant |
| 1365-P.A. | PR | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787875200000",
"number": "1497473896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4703 S MILL AVE",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852826721",
"telephone_number": "786-320-3048"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9096 SW 36TH MNR",
"city": "MIRAMAR",
"state": "FL",
"postal_code": "330257964",
"telephone_number": "786-320-3048"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INNOCENT",
"first_name": "ERIC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-08-22",
"last_updated": "2026-08-28",
"certification_date": "2026-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PR",
"license": "1365-P.A.",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physician Assistant",
"state": "AZ",
"license": "10296",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Miramar, FL
- Infinite Behavior Therapy Inc
- Infinite Caregiving, LLC. (Infinite Caregiving)
- Injury Med Express Pharmacy, LLC
- Injury RX LLC
- Claudia Innocent
- Innovative Care II, LLC
- Innovative Care Inc
- Innovative Investors Holdings Corp (Family Center For Healing)
- Insight Optical
- Inspire Behavioral Health Center Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.