Healthcare Provider Details

I. General information

NPI: 1609234855
Provider Name (Legal Business Name): FATIMA PERALTA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5409 N STATE ROAD 7
TAMARAC FL
33319-2921
US

IV. Provider business mailing address

619 S 28TH AVE
HOLLYWOOD FL
33020-4701
US

V. Phone/Fax

Practice location:
  • Phone: 954-526-9477
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9284953
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: