Healthcare Provider Details

I. General information

NPI: 1104869460
Provider Name (Legal Business Name): PAMELA ELAINE FORECKI ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 SOUTHWINDS DR
LANTANA FL
33462-1459
US

IV. Provider business mailing address

3002 BLACK OAK CT
BOYNTON BEACH FL
33436-6604
US

V. Phone/Fax

Practice location:
  • Phone: 561-547-6800
  • Fax: 561-547-6865
Mailing address:
  • Phone: 562-733-7302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberARNP1295782
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: