Pennycooke, Hereward
Pennycooke, Hereward is an sole proprietor health care provider with primary practice located at 3489 Nw 24Th St , Lauderdale Lakes FL 33311-2610. He recently has only one registered license in Nursing Service Related Providers / Attendant Care Provider, which is considered as his primary health care specialty. Pennycooke, Hereward can be contacted via phone (954) 822-3092.Contact Information
Primary practice address
3489 Nw 24Th St
Lauderdale Lakes FL 33311-2610
Phone: (954) 822-3092
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Nursing Service Related Providers / Attendant Care Provider | 3747A0650X | 11754900 | Florida |
Profile Details
| NPI number | 1053072421 |
|---|---|
| LBN Legal business name | Pennycooke, Hereward |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 6th, 2022 |
| Last updated | Jan 6th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1053072421 | NPPES |
| Florida | MEDICAID | 3747A0650X |
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