Healthcare Provider Details

I. General information

NPI: 1811237290
Provider Name (Legal Business Name): CARLENE NUGENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2013
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 N 72ND WAY
HOLLYWOOD FL
33024-2423
US

IV. Provider business mailing address

3130 N 72ND WAY
HOLLYWOOD FL
33024
US

V. Phone/Fax

Practice location:
  • Phone: 754-244-8299
  • Fax:
Mailing address:
  • Phone: 754-244-8299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: