Healthcare Provider Details

I. General information

NPI: 1447001383
Provider Name (Legal Business Name): ELIZABETH ASIN VENEREO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 07/27/2024
Certification Date: 07/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 SHERIDAN ST STE 109
HOLLYWOOD FL
33026-1501
US

IV. Provider business mailing address

7676 NW 180TH TER
HIALEAH FL
33015-6139
US

V. Phone/Fax

Practice location:
  • Phone: 954-961-8400
  • Fax: 954-961-8401
Mailing address:
  • Phone: 954-706-0064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11032012
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11032012
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: