Healthcare Provider Details

I. General information

NPI: 1376966614
Provider Name (Legal Business Name): NLH BOCAMED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 ROYAL PALM WAY PH 302
BOCA RATON FL
33432-7879
US

IV. Provider business mailing address

19 ROYAL PALM WAY PH 302
BOCA RATON FL
33432-7879
US

V. Phone/Fax

Practice location:
  • Phone: 561-558-6577
  • Fax:
Mailing address:
  • Phone: 561-558-6577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberARNP9162696
License Number StateFL

VIII. Authorized Official

Name: MS. NANCY L HARRIS
Title or Position: PRESIDENT
Credential: ARNP
Phone: 561-558-6577