Healthcare Provider Details

I. General information

NPI: 1457343519
Provider Name (Legal Business Name): PENELOPE ANN CUOCO A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N HIATUS RD STE 201
PEMBROKE PINES FL
33026-5213
US

IV. Provider business mailing address

500 N HIATUS RD STE 201
PEMBROKE PINES FL
33026-5213
US

V. Phone/Fax

Practice location:
  • Phone: 954-381-8989
  • Fax: 954-381-8950
Mailing address:
  • Phone: 954-381-8989
  • Fax: 954-381-8950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP1521692
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: