Healthcare Provider Details

I. General information

NPI: 1720516974
Provider Name (Legal Business Name): POLINA GOLDENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NW 9TH CT STE 103
BOCA RATON FL
33486-2268
US

IV. Provider business mailing address

1000 NW 9TH CT STE 103
BOCA RATON FL
33486-2268
US

V. Phone/Fax

Practice location:
  • Phone: 561-338-9811
  • Fax:
Mailing address:
  • Phone: 561-338-9811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN9377813
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberCNM04179
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: