Healthcare Provider Details

I. General information

NPI: 1083230312
Provider Name (Legal Business Name): FLORIDA PRACTITIONERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 E OAKLAND PARK BLVD STE 310
FORT LAUDERDALE FL
33306-1138
US

IV. Provider business mailing address

1995 E OAKLAND PARK BLVD STE 310
FORT LAUDERDALE FL
33306-1138
US

V. Phone/Fax

Practice location:
  • Phone: 866-996-8011
  • Fax:
Mailing address:
  • Phone: 866-996-8011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number State

VIII. Authorized Official

Name: BRANDI L HOLMES
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 386-882-8736