Healthcare Provider Details

I. General information

NPI: 1649757477
Provider Name (Legal Business Name): MRS. YASHERAH ANNGELL BALGOBIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 S CONGRESS AVE
ATLANTIS FL
33462-1197
US

IV. Provider business mailing address

7700 W SUNRISE BLVD STE 200
PLANTATION FL
33322-4113
US

V. Phone/Fax

Practice location:
  • Phone: 561-965-7300
  • Fax:
Mailing address:
  • Phone: 800-434-2672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9265524
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: