Healthcare Provider Details

I. General information

NPI: 1568378180
Provider Name (Legal Business Name): FKOG NP SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 W WATERFORD DR
DAVIE FL
33331-3215
US

IV. Provider business mailing address

5620 W WATERFORD DR
DAVIE FL
33331-3215
US

V. Phone/Fax

Practice location:
  • Phone: 954-993-5595
  • Fax:
Mailing address:
  • Phone: 954-993-5595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. FRIDAH K ORINA
Title or Position: OWNER, PROVIDER
Credential: APRN-C
Phone: 954-993-5595