Healthcare Provider Details

I. General information

NPI: 1558043265
Provider Name (Legal Business Name): PHOEBE MAGANA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7367 PANACHE WAY
BOCA RATON FL
33433-6940
US

IV. Provider business mailing address

7367 PANACHE WAY
BOCA RATON FL
33433-6940
US

V. Phone/Fax

Practice location:
  • Phone: 561-931-7873
  • Fax:
Mailing address:
  • Phone: 561-931-7873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11027838
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: