Healthcare Provider Details

I. General information

NPI: 1740632462
Provider Name (Legal Business Name): DAMION TENN ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

10397 SW 17TH DR
DAVIE FL
33324-7462
US

V. Phone/Fax

Practice location:
  • Phone: 954-987-2000
  • Fax:
Mailing address:
  • Phone: 954-205-9814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberARNP9219517
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: