Healthcare Provider Details

I. General information

NPI: 1285114975
Provider Name (Legal Business Name): PAUL DOMINIQUE SENATUS ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 E OAKLAND PARK BLVD STE 250
FORT LAUDERDALE FL
33306-1149
US

IV. Provider business mailing address

15251 SW 46TH CT
MIRAMAR FL
33027-3637
US

V. Phone/Fax

Practice location:
  • Phone: 954-791-6146
  • Fax:
Mailing address:
  • Phone: 786-876-6903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9296971
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: