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General NPI Number Information
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NPI Number | 1336477397
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Entity Type | Organization
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Legal Business Name | NOVA SOUTHEASTERN UNIVERSITY
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Dates
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Enumeration Date | 12/02/2009
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 8501 SW 124TH AVE STE 111
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City | MIAMI
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State | FL
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Zip | 33183-4631
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Country | US
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Telephone | 305-275-2601
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Fax | 305-274-8075
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Provider Business Mailing Address
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Address Line | PO BOX 290370
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City | DAVIE
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State | FL
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Zip | 33329-0370
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Country | US
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Telephone | 305-275-2601
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Fax | 305-274-8075
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Authorized Official
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Title or Position | DIR CONTRACTING AND CRED
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Name | ROSEMERY ESTEVEZ
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Credential |
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Telephone | 954-262-4343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 680074-3
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number |
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License Number State |
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