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General NPI Number Information
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NPI Number | 1689039000
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Entity Type | Organization
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Legal Business Name | SOUTH FLORIDA ANTI-AGING & AESTHETICS, LLC
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Dates
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Enumeration Date | 12/30/2015
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Last Update Date | 12/30/2015
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Provider Practice Location Address
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Address Line | 500 SE 17TH ST 200
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2547
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Country | US
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Telephone | 954-906-0399
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Fax |
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Provider Business Mailing Address
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Address Line | 2050 PARKSIDE CIR S
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City | BOCA RATON
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State | FL
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Zip | 33486-8569
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Country | US
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Telephone | 954-906-0399
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Fax | 954-906-0399
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER
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Name | DR. JENNIFER STONE
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Credential | DNP, ARNP, FNP-BC
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Telephone | 954-906-0399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | ARNP9182895
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License Number State | FL
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