Healthcare Provider Details

I. General information

NPI: 1497280341
Provider Name (Legal Business Name): MAREA KEFALAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 07/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST MRH TOTAL HEART CENTER
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
HOLLYWOOD FL
33021-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-7750
  • Fax:
Mailing address:
  • Phone: 954-276-5685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9295476
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: