Healthcare Provider Details

I. General information

NPI: 1316536956
Provider Name (Legal Business Name): AYISHA FABLE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2021
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 S POWERLINE RD STE B
POMPANO BEACH FL
33069-4310
US

IV. Provider business mailing address

1451 W CYPRESS CREEK RD STE 300
FORT LAUDERDALE FL
33309-1953
US

V. Phone/Fax

Practice location:
  • Phone: 954-940-2231
  • Fax:
Mailing address:
  • Phone: 954-940-2231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11010980
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: