Healthcare Provider Details

I. General information

NPI: 1063368470
Provider Name (Legal Business Name): NOEL PACHECO MACHADO FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 S STATE ROAD 7
HOLLYWOOD FL
33023-6718
US

IV. Provider business mailing address

741 NW 45TH AVE APT 20
MIAMI FL
33126-2466
US

V. Phone/Fax

Practice location:
  • Phone: 954-743-5522
  • Fax:
Mailing address:
  • Phone: 321-353-0662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11045869
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: