Healthcare Provider Details

I. General information

NPI: 1780027870
Provider Name (Legal Business Name): SOUTH BROWARD HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4651 SHERIDAN STREET SUITE 150
HOLLYWOOD FL
33024
US

IV. Provider business mailing address

2900 CORPORATE WAY MPG DOOR D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-6331
  • Fax: 954-965-6480
Mailing address:
  • Phone: 954-276-5581
  • Fax: 954-985-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NINA BEAUCHESNE
Title or Position: SR. VICE PRESIDENT
Credential:
Phone: 954-265-6996