Healthcare Provider Details

I. General information

NPI: 1346866613
Provider Name (Legal Business Name): DERLINE JULIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N STATE ROAD 7 STE 300
LAUDERHILL FL
33313-5853
US

IV. Provider business mailing address

1600 N STATE ROAD 7 STE 300
LAUDERHILL FL
33313-5853
US

V. Phone/Fax

Practice location:
  • Phone: 954-581-1977
  • Fax:
Mailing address:
  • Phone: 954-581-1977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11005493
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: