Healthcare Provider Details

I. General information

NPI: 1225277650
Provider Name (Legal Business Name): NOVA SOUTHEASTERN UNIVERSITY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16855 NE 2ND AVE STE N302
NORTH MIAMI BEACH FL
33162-1744
US

IV. Provider business mailing address

3200 S. UNIVERSITY DRIVE SANFORD L. ZIFF BLDG. 3RD FLOOR ROOM 4364-D
FT. LAUDERDALE FL
33328-2018
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-4200
  • Fax:
Mailing address:
  • Phone: 954-262-4343
  • Fax: 954-262-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ROSEMERY ESTEVEZ
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 954-262-4343