Healthcare Provider Details

I. General information

NPI: 1467207571
Provider Name (Legal Business Name): AMY GELETKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W CYPRESS CREEK RD STE B106
FORT LAUDERDALE FL
33309-1718
US

IV. Provider business mailing address

2700 W CYPRESS CREEK RD STE B106
FORT LAUDERDALE FL
33309-1718
US

V. Phone/Fax

Practice location:
  • Phone: 954-514-7569
  • Fax: 954-514-7659
Mailing address:
  • Phone: 954-514-7569
  • Fax: 954-514-7659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License NumberNH6530
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: