Healthcare Provider Details

I. General information

NPI: 1114704350
Provider Name (Legal Business Name): ELISABETH C LA ROTTA NUNEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 05/27/2024
Certification Date: 05/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 CORAL HILLS DR STE 370
CORAL SPRINGS FL
33065-4146
US

IV. Provider business mailing address

2901 CORAL HILLS DR STE 370
CORAL SPRINGS FL
33065-4146
US

V. Phone/Fax

Practice location:
  • Phone: 954-603-9630
  • Fax:
Mailing address:
  • Phone: 954-756-3927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9576786
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11033001
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: