Healthcare Provider Details

I. General information

NPI: 1699124552
Provider Name (Legal Business Name): DAVID ERICKSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 NW 62ND ST
FORT LAUDERDALE FL
33309-1831
US

IV. Provider business mailing address

1525 NW 62ND ST
FORT LAUDERDALE FL
33309-1831
US

V. Phone/Fax

Practice location:
  • Phone: 800-437-2672
  • Fax:
Mailing address:
  • Phone: 800-437-2672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberC-APN.0100402
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: