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General NPI Number Information
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NPI Number | 1679595763
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | 1201 NW 16TH ST
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City | MIAMI
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State | FL
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Zip | 33125-1624
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Country | US
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Telephone | 305-575-7000
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Fax | 305-575-7079
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Provider Business Mailing Address
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Address Line | 10650 NW 30TH PL #5
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City | SUNRISE
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State | FL
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Zip | 33322-1052
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Country | US
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Telephone | 954-748-4585
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Fax |
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Authorized Official
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Title or Position | STAFF ARNP IN PRIMARY CARE
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Name | MISS NANCY CAROL HARTKOP
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Credential | ARNP-BC
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Telephone | 305-575-7000
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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 | ARNP 58883-2
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License Number State | FL
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