Healthcare Provider Details

I. General information

NPI: 1326584970
Provider Name (Legal Business Name): NELLY FOEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2017
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 ROYAL WAY
TAMARAC FL
33321
US

IV. Provider business mailing address

5959 ROYAL WAY
TAMARAC FL
33321-4161
US

V. Phone/Fax

Practice location:
  • Phone: 754-802-6219
  • Fax:
Mailing address:
  • Phone: 754-802-6219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH23915
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: