=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063102796
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA T ORMAZA NURSE PRACTITIONER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2023
-----------------------------------------------------
Last Update Date | 05/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5400 S UNIVERSITY DR
-----------------------------------------------------
City | DAVIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33328-5312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-540-5848
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5802 SW 112TH WAY
-----------------------------------------------------
City | COOPER CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33330-4553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-746-3875
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | APRN11023655
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------