Healthcare Provider Details

I. General information

NPI: 1962035477
Provider Name (Legal Business Name): CARRIE SHUMPERT FALOWSKI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 12/02/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7369 SHERIDAN ST STE 302
HOLLYWOOD FL
33024-2776
US

IV. Provider business mailing address

3141 SW 20TH CT
FORT LAUDERDALE FL
33312-3731
US

V. Phone/Fax

Practice location:
  • Phone: 954-276-1925
  • Fax: 954-276-0675
Mailing address:
  • Phone: 954-829-0194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9301660
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN9301660
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: