Mildred Taveras, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9102769 Issued in FL

Practice address

12177 Pembroke Rd
Pembroke Pines, FL 33025-1727

Phone

(954) 436-0555

Fax

(954) 436-0108

NPI assigned

Jan 3, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• PCC Medical Holdings LLC

  • Internal Medicine Physician
  • Lake Worth, FL
  • NPI 1174167993
  Medicare reassignment NPD

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

{
    "created_epoch": "1294012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379376000000",
    "number": "1689978843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12177 PEMBROKE RD",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330251727",
            "telephone_number": "954-436-0555",
            "fax_number": "954-433-0108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12177 PEMBROKE RD",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330251727",
            "telephone_number": "954-436-0555",
            "fax_number": "954-436-0108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVERAS",
        "first_name": "MILDRED",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-03",
        "last_updated": "2013-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9102769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victor Tatis de la Nuez, ARNP
• Matthew Alan Taub, M.D.
• Carolina Caridad Tauler
• Jonathan Meir Taus, D.O
• Larissa Lima Tavares, MD
• Brian G Taylor, COTA
• Eric Taylor
• Jacob Thomas Taylor, PT, DPT
• Nathan Andrew Taylor, AP
• Valerie Taylor

• Physician Assistant in Pembroke Pines, FL
• Providers in Pembroke Pines, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2013; 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.

Verify at the official NPI Registry.