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General NPI Number Information
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NPI Number | 1457781072
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Entity Type | Individual
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Provider Name | FANNY TSE PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/18/2013
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Last Update Date | 10/23/2019
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Provider Practice Location Address
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Address Line | 21150 BISCAYNE BLVD STE 208
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City | AVENTURA
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State | FL
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Zip | 33180-1231
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Country | US
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Telephone | 954-482-4747
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Fax |
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Provider Business Mailing Address
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Address Line | 829 SW 13TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33315-1448
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Country | US
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Telephone | 954-993-7084
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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 | PA 9107621
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License Number State | FL
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