Healthcare Provider Details

I. General information

NPI: 1386486264
Provider Name (Legal Business Name): FAU BROWARD HEALTH ACADEMIC PRACTICE PLAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W SAMPLE RD STE 207
DEERFIELD BEACH FL
33064-3547
US

IV. Provider business mailing address

2100 E SAMPLE RD STE 101
LIGHTHOUSE POINT FL
33064-7574
US

V. Phone/Fax

Practice location:
  • Phone: 954-958-7195
  • Fax: 954-958-7115
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JERRY CAPOTE
Title or Position: MD/CEO
Credential: MD
Phone: 954-786-6449