Healthcare Provider Details

I. General information

NPI: 1447064894
Provider Name (Legal Business Name): META SUSAN KNOBLAUCH NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

8233 CADRE NOIR RD
LAKE WORTH FL
33467-6703
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-5831
  • Fax:
Mailing address:
  • Phone: 704-576-4009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number11037487
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: