Healthcare Provider Details

I. General information

NPI: 1457263881
Provider Name (Legal Business Name): SILVER LEAF MED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 CELEBRATION PL W APT 301
MARGATE FL
33063-3936
US

IV. Provider business mailing address

2850 CELEBRATION PL W APT 301
MARGATE FL
33063-3936
US

V. Phone/Fax

Practice location:
  • Phone: 954-870-0261
  • Fax: 954-827-3249
Mailing address:
  • Phone: 954-870-0261
  • Fax: 954-827-3249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. STACY KERRIAN WILLIAMS
Title or Position: OWNER
Credential: DNP
Phone: 954-870-0261