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NPI Code Detail

MEDICARE: ERLANGE MARCELLUS NURSE PRACTITIONER

MEDICARE: ERLANGE MARCELLUS NURSE PRACTITIONER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN9304175FL
2363LF0000XFamily Nurse Practitioner11011379FL

General Provider Information

NPI Number : 1427642412
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERLANGE MARCELLUS NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 5480 GRIFFIN RD
Second Line :
City : DAVIE
State : FL
Zip : 33314-4539
Country : US
Telephone Number : 954-210-9770
Fax Number :
Provider Business Practice Location Address
First Line : 5480 GRIFFIN RD
Second Line :
City : DAVIE
State : FL
Zip : 33314-4539
Country : US
Telephone Number : 954-210-9770
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2021
Last Update Date : 02/22/2021

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Directions to “ ERLANGE MARCELLUS NURSE PRACTITIONER” Practice Location

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