Active NPI
Camilla Amy Mirkin, MS, RD, LDN
- Registered Dietitian
- Pembroke Pines, FL
National Provider Identifier
1548089428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- ND13655
- Practice address
- 18331 Pines Blvd Ste 254
Pembroke Pines, FL 33029-1421 - Phone
- (954) 866-3418
- NPI assigned
- Oct 7, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | ND13655 | FL | Primary |
Addresses
Primary practice location
18331 Pines Blvd Ste 254
Pembroke Pines, FL 33029-1421
Mailing address
18331 Pines Blvd Ste 254
Pembroke Pines, FL 33029-1421
Phone (954) 866-3418
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ND13655 | FL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730332800000",
"number": "1548089428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18331 PINES BLVD STE 254",
"city": "PEMBROKE PINES",
"state": "FL",
"postal_code": "330291421",
"telephone_number": "954-866-3418"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18331 PINES BLVD STE 254",
"city": "PEMBROKE PINES",
"state": "FL",
"postal_code": "330291421",
"telephone_number": "954-866-3418"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRKIN",
"first_name": "CAMILLA",
"middle_name": "AMY",
"credential": "MS, RD, LDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-10-07",
"last_updated": "2024-10-31",
"certification_date": "2024-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "FL",
"license": "ND13655",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pembroke Pines, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.