Provider Demographics
NPI:1497298558
Name:PHILORD, JOHN TASSY (ARNP, NP-C)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:TASSY
Last Name:PHILORD
Suffix:
Gender:M
Credentials:ARNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6871 SW 39TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-6634
Mailing Address - Country:US
Mailing Address - Phone:305-725-4717
Mailing Address - Fax:
Practice Address - Street 1:6871 SW 39TH CT
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-6634
Practice Address - Country:US
Practice Address - Phone:305-725-4717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9248807363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care