Healthcare Provider Details

I. General information

NPI: 1720126584
Provider Name (Legal Business Name): NOVA SOUTHEASTERN UNIVERSITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 COLLEGE AVE UNIVERSITY CENTER ROOM 1433
FT. LAUDERDALE FL
33314-7721
US

IV. Provider business mailing address

3200 S UNIVERSITY DR SANFORD L. ZIFF BLDG, 3RD FLOOR, ROOM 4364-D
FORT LAUDERDALE FL
33328-2018
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-5590
  • Fax: 954-262-5570
Mailing address:
  • Phone: 954-262-4343
  • Fax: 954-262-1172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ROSEMERY ESTEVEZ
Title or Position: DIR OF CONTRACTING AND CREDEN
Credential:
Phone: 954-262-4343