Healthcare Provider Details

I. General information

NPI: 1003212762
Provider Name (Legal Business Name): RALITZA GEORGIEVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2014
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7420 NW 5TH ST SUITE 103
PLANTATION FL
33317-1611
US

IV. Provider business mailing address

7420 NW 5TH ST SUITE 103
PLANTATION FL
33317-1611
US

V. Phone/Fax

Practice location:
  • Phone: 954-474-4704
  • Fax: 954-587-8686
Mailing address:
  • Phone: 954-474-4704
  • Fax: 954-587-8686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberARNP 9292120
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: