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General NPI Number Information
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NPI Number | 1295512010
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Entity Type | Individual
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Provider Name | MARIE-ALTAGRACE VANESSA GERMAIN
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Gender | Female
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Dates
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Enumeration Date | 09/14/2023
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 3000 BAYVIEW DR
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City | FORT LAUDERDALE
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State | FL
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Zip | 33306-1772
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Country | US
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Telephone | 954-567-1332
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Fax |
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Provider Business Mailing Address
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Address Line | 6811 NW 27TH SREET
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City | MARGATE
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State | FL
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Zip | 33063
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Country | US
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Telephone | 561-674-2031
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9441425
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11028664
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License Number State | FL
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