Healthcare Provider Details

I. General information

NPI: 1043520091
Provider Name (Legal Business Name): AHP OF SOUTH BROWARD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 SHERIDAN ST SUITE 106
HOLLYWOOD FL
33026-1505
US

IV. Provider business mailing address

3079 PEACHTREE INDUSTRIAL BLVD
DULUTH GA
30097-2215
US

V. Phone/Fax

Practice location:
  • Phone: 645-435-0101
  • Fax:
Mailing address:
  • Phone: 770-945-5330
  • Fax: 678-546-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: ALLISON ROSE BLASETTI
Title or Position: DIRECTOR CREDENTIALING & ENROLLMENT
Credential:
Phone: 770-945-5330