Healthcare Provider Details

I. General information

NPI: 1497265441
Provider Name (Legal Business Name): ALBERTO MACENA NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 N UNIVERSITY DR
TAMARAC FL
33321-2913
US

IV. Provider business mailing address

4059 NW 115TH AVE
CORAL SPRINGS FL
33065-7265
US

V. Phone/Fax

Practice location:
  • Phone: 954-721-2200
  • Fax:
Mailing address:
  • Phone: 786-587-2827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9304607
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: