Healthcare Provider Details

I. General information

NPI: 1669589180
Provider Name (Legal Business Name): NICHOLE ALIDA CRENSHAW ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18688 SW 16TH ST
PEMBROKE PINES FL
33029-6133
US

IV. Provider business mailing address

18688 SW 16TH ST
PEMBROKE PINES FL
33029-6133
US

V. Phone/Fax

Practice location:
  • Phone: 954-885-0614
  • Fax:
Mailing address:
  • Phone: 954-885-0614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN2810992
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number2810992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: