Healthcare Provider Details

I. General information

NPI: 1528418357
Provider Name (Legal Business Name): JAMES MADDERN SELLERS IV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAMES MADDERN SELLERS IV DNP

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 WOODBINE RD
PACE FL
32571-8768
US

IV. Provider business mailing address

5565 WOODBINE RD
PACE FL
32571-8768
US

V. Phone/Fax

Practice location:
  • Phone: 954-495-9833
  • Fax: 448-220-2266
Mailing address:
  • Phone: 954-495-9833
  • Fax: 448-220-2266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9267401
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: