Healthcare Provider Details

I. General information

NPI: 1437500287
Provider Name (Legal Business Name): SOUTH BROWARD HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 SHERIDAN ST FL 1
PEMBROKE PINES FL
33024-2536
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-883-8014
  • Fax: 954-986-8306
Mailing address:
  • Phone: 954-276-5685
  • Fax: 954-985-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: NINA BEAUCHESNE
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 954-265-6996