Healthcare Provider Details

I. General information

NPI: 1255812962
Provider Name (Legal Business Name): OVI NODARSE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6129 SW 70TH ST
SOUTH MIAMI FL
33143-3451
US

IV. Provider business mailing address

1751 BONAVENTURE BLVD
WESTON FL
33326-4039
US

V. Phone/Fax

Practice location:
  • Phone: 786-871-6854
  • Fax: 786-871-6801
Mailing address:
  • Phone: 954-656-3181
  • Fax: 954-656-3188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9376506
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9376506
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: