Healthcare Provider Details

I. General information

NPI: 1477580165
Provider Name (Legal Business Name): ARTHUR GLICK APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ARTHUR GLICK N.P.

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 NW 150TH AVE STE 120
PEMBROKE PINES FL
33028-2888
US

IV. Provider business mailing address

2010 NW 150TH AVE STE 120
PEMBROKE PINES FL
33028-2888
US

V. Phone/Fax

Practice location:
  • Phone: 954-431-9838
  • Fax: 954-241-6726
Mailing address:
  • Phone: 954-431-9838
  • Fax: 954-241-6726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF303765
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN9240690
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: