Healthcare Provider Details

I. General information

NPI: 1013838168
Provider Name (Legal Business Name): DANIELLE FORDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 NW 4TH ST
PLANTATION FL
33317-2708
US

IV. Provider business mailing address

4440 NW 4TH ST
PLANTATION FL
33317-2708
US

V. Phone/Fax

Practice location:
  • Phone: 954-610-2118
  • Fax:
Mailing address:
  • Phone: 954-610-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11045722
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: