Healthcare Provider Details

I. General information

NPI: 1053109439
Provider Name (Legal Business Name): ALLISON NICOLE BARDILL APRN, CPNP-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 SE 8TH AVE
POMPANO BEACH FL
33060-8052
US

IV. Provider business mailing address

470 SE 8TH AVE
POMPANO BEACH FL
33060-8052
US

V. Phone/Fax

Practice location:
  • Phone: 954-850-5533
  • Fax:
Mailing address:
  • Phone: 954-850-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number309833
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11015957
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: