Healthcare Provider Details

I. General information

NPI: 1003725433
Provider Name (Legal Business Name): ILEEN TALEBZADEH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

954 NW 126TH AVE
POMPANO BEACH FL
33071-4433
US

IV. Provider business mailing address

954 NW 126TH AVE
POMPANO BEACH FL
33071-4433
US

V. Phone/Fax

Practice location:
  • Phone: 954-226-2240
  • Fax:
Mailing address:
  • Phone: 954-226-2240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11050667
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: