Healthcare Provider Details

I. General information

NPI: 1881175495
Provider Name (Legal Business Name): ELIZABETH JACKIE BAGUIDY-EUGENE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6931 W SUNRISE BLVD
PLANTATION FL
33313-4406
US

IV. Provider business mailing address

4010 PALMETTO TRL
WESTON FL
33331-3820
US

V. Phone/Fax

Practice location:
  • Phone: 954-583-6200
  • Fax:
Mailing address:
  • Phone: 954-394-5397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number6794
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: