Healthcare Provider Details

I. General information

NPI: 1497076871
Provider Name (Legal Business Name): FERNIDE OBAS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2010
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 S FLAMINGO RD
COOPER CITY FL
33330-2312
US

IV. Provider business mailing address

4701 S FLAMINGO RD
COOPER CITY FL
33330-2312
US

V. Phone/Fax

Practice location:
  • Phone: 954-434-3160
  • Fax:
Mailing address:
  • Phone: 954-434-3160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number9206283
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9206283
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: