Healthcare Provider Details

I. General information

NPI: 1598409609
Provider Name (Legal Business Name): BIANCA KRYSTAL BACHOO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 W SUNRISE BLVD
FORT LAUDERDALE FL
33311-7131
US

IV. Provider business mailing address

906 W SUNRISE BLVD
FORT LAUDERDALE FL
33311-7131
US

V. Phone/Fax

Practice location:
  • Phone: 844-650-2626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11016762
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: