Healthcare Provider Details

I. General information

NPI: 1922666312
Provider Name (Legal Business Name): CONCEPCION FORNARIS CABALLERO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6351 ADAMS ST
HOLLYWOOD FL
33023-1749
US

IV. Provider business mailing address

6351 ADAMS ST
HOLLYWOOD FL
33023-1749
US

V. Phone/Fax

Practice location:
  • Phone: 954-638-6924
  • Fax:
Mailing address:
  • Phone: 954-638-6924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11002534
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number11002534
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11002534
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: