Healthcare Provider Details

I. General information

NPI: 1932231297
Provider Name (Legal Business Name): CAROL M APOLLON BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 N STATE ROAD 7
LAUDERDALE LAKES FL
33319-5860
US

IV. Provider business mailing address

10240 S.W. 12 STREET
PEM BROKE PINES FL
33025
US

V. Phone/Fax

Practice location:
  • Phone: 954-677-1812
  • Fax: 954-497-3857
Mailing address:
  • Phone: 954-436-3867
  • Fax: 954-497-3857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: