Healthcare Provider Details

I. General information

NPI: 1932943479
Provider Name (Legal Business Name): FAU BROWARD HEALTH ACADEMIC PRACTICE PLAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

6405 N FEDERAL HWY STE 404
FORT LAUDERDALE FL
33308-1414
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: 954-958-7195
  • Fax: 954-958-7115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

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