Healthcare Provider Details

I. General information

NPI: 1619575784
Provider Name (Legal Business Name): SHAQUIRA WELLS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

1601 NW 55TH AVE
LAUDERHILL FL
33313-5453
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-2000
  • Fax:
Mailing address:
  • Phone: 305-742-1791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9314377
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: