Healthcare Provider Details

I. General information

NPI: 1366367344
Provider Name (Legal Business Name): JENA FATIMA NASSAR OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

IV. Provider business mailing address

12851 SW 26TH ST
DAVIE FL
33325-5610
US

V. Phone/Fax

Practice location:
  • Phone: 954-439-5564
  • Fax:
Mailing address:
  • Phone: 954-439-5564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC7048
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: