Healthcare Provider Details

I. General information

NPI: 1063285005
Provider Name (Legal Business Name): MARLON HINDS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S PARK RD FL 33021 SUITE 400
HOLLYWOOD FL
33021-8593
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-7450
  • Fax: 954-265-7459
Mailing address:
  • Phone: 954-290-0086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11029471
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: