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General NPI Number Information
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NPI Number | 1558497370
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Entity Type | Organization
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Legal Business Name | KIDS KLINIC, BROWARD CHILDREN CENTER
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1055 SW 44TH AVE
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City | PLANTATION
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State | FL
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Zip | 33317-4535
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Country | US
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Telephone | 954-584-7205
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Fax |
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Provider Business Mailing Address
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Address Line | 114 SE 20TH AVE
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City | POMPANO BEACH
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State | FL
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Zip | 33060-7547
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Country | US
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Telephone | 954-933-0597
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Fax | 954-941-1164
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MS. SONIA SMITH
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Credential | ARNP
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Telephone | 954-933-0597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ARNP 1830552
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License Number State | FL
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