Healthcare Provider Details

I. General information

NPI: 1275040057
Provider Name (Legal Business Name): ANGELA VACHARAKIAT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N 35TH AVE STE 575
HOLLYWOOD FL
33021-5469
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-3437
  • Fax: 954-983-5052
Mailing address:
  • Phone: 954-276-5685
  • Fax: 954-985-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9224495
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: