Healthcare Provider Details

I. General information

NPI: 1902028434
Provider Name (Legal Business Name): SOUTH BROWARD NEPHROLOGY & HYPERTENSION ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 WASHINGTON ST SUITE 500
HOLLYWOOD FL
33021-8256
US

IV. Provider business mailing address

3700 WASHINGTON ST SUITE 500
HOLLYWOOD FL
33021-8256
US

V. Phone/Fax

Practice location:
  • Phone: 954-962-0338
  • Fax: 954-962-2357
Mailing address:
  • Phone: 954-962-0338
  • Fax: 954-962-2357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME22201
License Number StateFL

VIII. Authorized Official

Name: MRS. FRAN VAN GELDER
Title or Position: OFFICE ADMINISTRATOR
Credential: ARNP
Phone: 954-364-4903