Camilla Amy Mirkin, MS, RD, LDN
Dietitian, Registered in Pembroke Pines, FL. Individual provider (NPI-1).
NPI number1548089428
StatusActive
Last updated in NPPESOct 31, 2024
Details
- NPI
- 1548089428
- Entity type
- Individual (NPI-1)
- Name
- Camilla Amy Mirkin
- Credential
- MS, RD, LDN
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Oct 7, 2024
- Certification date
- Oct 31, 2024
- Last updated
- Oct 31, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 133V00000X | Dietitian, Registered | ND13655 | FL | Yes |
Practice location
18331 Pines Blvd Ste 254Pembroke Pines, FL 33029-1421
Phone 954-866-3418
Mailing address
18331 Pines Blvd Ste 254Pembroke Pines, FL 33029-1421
Phone 954-866-3418
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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