| Dr Wentworth Jarrett Pa | |
|
12955 Sw 132nd St Bldg 3b Suite 104 Miami FL 33186-7205 | |
| (305) 520-5750 | |
| (305) 520-5754 |
| Full Name | Dr Wentworth Jarrett Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 12955 Sw 132nd St, Miami, Florida |
| Authorized Official Name and Position | Wentworth G Jarrett (OWNER) |
| Authorized Official Contact | 3055205750 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Wentworth Jarrett Pa 12955 Sw 132nd St Bldg 3b Suite 104 Miami FL 33186-7205 Ph: (305) 520-5750 | Dr Wentworth Jarrett Pa 12955 Sw 132nd St Bldg 3b Suite 104 Miami FL 33186-7205 Ph: (305) 520-5750 |
| NPI Number | 1366637951 |
|---|---|
| Provider Enumeration Date | 09/07/2007 |
| Last Update Date | 06/06/2012 |
| Medicare PECOS PAC ID | 9830260249 |
|---|---|
| Medicare Enrollment ID | O20080612000256 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366637951 | NPI | - | NPPES |
| D20890 | Other | FL | UPIN |
| 046128800 | Medicaid | FL | |
| 04162 | Other | FL | BC/BS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Wentworth Jarrett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104836972 PECOS PAC ID: 2668541616 Enrollment ID: I20080517000036 |
| Provider Name | Tanzie Avello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528489713 PECOS PAC ID: 6002091626 Enrollment ID: I20160908000793 |
| Provider Name | Tor Wentworth Jarrett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134617186 PECOS PAC ID: 2163826884 Enrollment ID: I20210803001666 |
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