MEDICARE: DAILE BORTNER APRN

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11032259	FL

General Provider Information

NPI Number	:	1518710284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAILE BORTNER APRN

Provider Business Mailing Address
First Line	:	PO BOX 848303
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33084-0303
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8403 PINES BLVD # 1318
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6609
Country	:	US
Telephone Number	:	954-980-5541
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2024
Last Update Date	:	08/02/2024

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Directions to “ DAILE BORTNER APRN” Practice Location

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