Healthcare Provider Details

I. General information

NPI: 1770184293
Provider Name (Legal Business Name): DEBSHEBA EMPIRE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 04/15/2023
Certification Date: 04/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4534 N UNIVERSITY DR
LAUDERHILL FL
33351-5740
US

IV. Provider business mailing address

4534 N UNIVERSITY DR
LAUDERHILL FL
33351-5740
US

V. Phone/Fax

Practice location:
  • Phone: 754-444-0054
  • Fax:
Mailing address:
  • Phone: 754-444-0054
  • Fax: 954-000-0000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. GINA DAYE
Title or Position: APRN
Credential: PHD, APRN
Phone: 754-444-0054