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General NPI Number Information
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NPI Number | 1588377949
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Entity Type | Organization
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Legal Business Name | ADVANCED MEDICAL PROVIDER INC
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Dates
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Enumeration Date | 01/02/2023
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Last Update Date | 01/02/2023
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Provider Practice Location Address
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Address Line | 1560 SAWGRASS CORPORATE PKWY FL 4
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City | SUNRISE
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State | FL
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Zip | 33323-2855
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Country | US
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Telephone | 954-600-8994
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Fax |
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Provider Business Mailing Address
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Address Line | 11510 SW 2ND ST
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City | PLANTATION
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State | FL
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Zip | 33325-2922
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Country | US
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Telephone | 954-600-8994
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JESSY MADHUKAR
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Credential | NP
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Telephone | 954-600-8994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number |
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License Number State |
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