Healthcare Provider Details

I. General information

NPI: 1215326533
Provider Name (Legal Business Name): WHIDLET NAISSANCE ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2788 SW 177TH AVE
MIRAMAR FL
33029-5142
US

IV. Provider business mailing address

2788 SW 177TH AVE
MIRAMAR FL
33029-5142
US

V. Phone/Fax

Practice location:
  • Phone: 561-635-7938
  • Fax:
Mailing address:
  • Phone: 561-635-7938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number9537589
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9357589
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9357589
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: