Healthcare Provider Details

I. General information

NPI: 1942501697
Provider Name (Legal Business Name): ADELLE M AZAM ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ADELLE M AZAM-BENNETT ARNP

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 CORAL HILLS DR STE 202
CORAL SPRINGS FL
33065-4139
US

IV. Provider business mailing address

1700 NW 49TH ST STE 125
FORT LAUDERDALE FL
33309-3750
US

V. Phone/Fax

Practice location:
  • Phone: 954-320-2640
  • Fax: 954-320-2610
Mailing address:
  • Phone: 954-320-2640
  • Fax: 954-320-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberARNP3261052
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberARNP3261052
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberARNP 3261052
License Number StateZZ
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP3261052
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3261052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: