Healthcare Provider Details

I. General information

NPI: 1760965438
Provider Name (Legal Business Name): ANDREA NADINE MUNROE-SERVICE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8395 W OAKLAND PARK BLVD STE C
SUNRISE FL
33351-7346
US

IV. Provider business mailing address

8395 W OAKLAND PARK BLVD STE C
SUNRISE FL
33351-7346
US

V. Phone/Fax

Practice location:
  • Phone: 561-404-1422
  • Fax: 561-404-1425
Mailing address:
  • Phone: 561-404-1422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN9186730
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: