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General NPI Number Information
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NPI Number | 1396094090
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Entity Type | Organization
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Legal Business Name | RAINFOREST FAMILY MEDICAL
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Dates
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Enumeration Date | 09/10/2012
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Last Update Date | 09/10/2012
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Provider Practice Location Address
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Address Line | 4699 N STATE ROAD 7 STE B2
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33319-5879
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Country | US
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Telephone | 954-717-8778
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Fax |
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Provider Business Mailing Address
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Address Line | 4699 N STATE ROAD 7 STE B2
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33319-5879
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Country | US
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Telephone | 954-717-8778
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MS. SHARON COSTANZO
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Credential | ARNP
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Telephone | 954-717-8778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | ARNP 787612
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License Number State | FL
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