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General NPI Number Information
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NPI Number | 1407244247
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Entity Type | Individual
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Provider Name | NICOLE OFFENBERG MCMSC, PA
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Gender | Female
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Dates
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Enumeration Date | 01/01/2015
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Last Update Date | 04/08/2015
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Provider Practice Location Address
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Address Line | 400 SW 1ST AVE APT. 407
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-3476
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Country | US
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Telephone | 954-294-9193
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Fax |
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Provider Business Mailing Address
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Address Line | 400 SW 1ST AVE APT. 407
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-3476
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Country | US
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Telephone | 954-294-9193
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PAT9108441
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9108441
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License Number State | FL
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