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General NPI Number Information
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NPI Number | 1407302045
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Entity Type | Organization
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Legal Business Name | BROWARD HEALTH
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 1800 SW 5TH PLACE
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City | FT. LAUDERDALE
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State | FL
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Zip | 33309
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Country | US
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Telephone | 754-323-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 2720 SOUTH OAKLAND FOREST DRIVE APT.907
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City | OAKLAND PARK
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State | FL
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Zip | 33309
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Country | US
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Telephone | 954-632-9809
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Fax |
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Authorized Official
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Title or Position | ATHLETIC TRAINER
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Name | JIMMY L. JEFFERSON JR.
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Credential |
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Telephone | 954-632-9809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number | AL 638
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License Number State | FL
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