Healthcare Provider Details

I. General information

NPI: 1548286784
Provider Name (Legal Business Name): ANNA M MUIR-FRAKER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA M FRAKER RD

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 10/23/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2719 HOLLYWOOD BLVD # L246
HOLLYWOOD FL
33020-4821
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-655-3455
  • Fax:
Mailing address:
  • Phone: 954-276-5685
  • Fax: 954-985-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND354
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: