Healthcare Provider Details

I. General information

NPI: 1851720296
Provider Name (Legal Business Name): NICOLE WHITFIELD-POWELL NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S ANDREWS AVE
FORT LAUDERDALE FL
33316-2510
US

IV. Provider business mailing address

2603 SW 85TH AVE
MIRAMAR FL
33025-2951
US

V. Phone/Fax

Practice location:
  • Phone: 954-355-4400
  • Fax: 954-355-4400
Mailing address:
  • Phone: 954-639-7696
  • Fax: 954-639-7696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9236335
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberARNP9236335
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: