Healthcare Provider Details

I. General information

NPI: 1306265376
Provider Name (Legal Business Name): STEVEN DANIEL BROCK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 N STATE ROAD 7
MARGATE FL
33063-5727
US

IV. Provider business mailing address

15000 BRISTOL LN
DAVIE FL
33331-3238
US

V. Phone/Fax

Practice location:
  • Phone: 954-974-0400
  • Fax:
Mailing address:
  • Phone: 954-434-0883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9266958
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: