Healthcare Provider Details

I. General information

NPI: 1487236030
Provider Name (Legal Business Name): ASSURED MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 04/23/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18741 NW 24TH CT
PEMBROKE PINES FL
33029-5352
US

IV. Provider business mailing address

18741 NW 24TH CT
PEMBROKE PINES FL
33029-5352
US

V. Phone/Fax

Practice location:
  • Phone: 954-790-2410
  • Fax:
Mailing address:
  • Phone: 954-790-2410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER PATINO
Title or Position: MGR
Credential: APRN
Phone: 954-790-2410