=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588392633
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARKS LAB SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2022
-----------------------------------------------------
Last Update Date | 08/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3801 N UNIVERSITY DR STE 402
-----------------------------------------------------
City | SUNRISE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33351-6320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-909-4309
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3801 N UNIVERSITY DR STE 402
-----------------------------------------------------
City | SUNRISE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33351-6320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-909-4309
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER/CO-FOUNDER
-----------------------------------------------------
Name | DR. BRENDA PARKER-PARKS
-----------------------------------------------------
Credential | DNP
-----------------------------------------------------
Telephone | 954-909-4309
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------