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General NPI Number Information
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NPI Number | 1356956403
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Entity Type | Individual
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Provider Name | GEORGINA EVELYN ANDERSON
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Gender | Female
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 02/12/2021
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Provider Practice Location Address
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Address Line | 3000 BAYVIEW DR STE 100
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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 | 561-537-2721
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Provider Business Mailing Address
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Address Line | 3930 CRYSTAL LAKE DR APT 309
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City | DEERFIELD BEACH
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State | FL
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Zip | 33064-1221
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Country | US
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Telephone | 954-464-5460
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11008198
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11008198
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License Number State | FL
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