Healthcare Provider Details

I. General information

NPI: 1740875483
Provider Name (Legal Business Name): THE EMPOWERED HUMAN PROJECT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 N UNIVERSITY DR STE C103
SUNRISE FL
33351-6243
US

IV. Provider business mailing address

1835 NW 58TH AVE
LAUDERHILL FL
33313-4022
US

V. Phone/Fax

Practice location:
  • Phone: 954-226-8234
  • Fax:
Mailing address:
  • Phone: 954-226-8234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NICOLAS AQUINO
Title or Position: PRESIDENT
Credential:
Phone: 954-226-8234