=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700912797
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH BROWARD HOSPITAL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 05/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 NW 7TH AVENUE
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33311-9026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-759-6988
-----------------------------------------------------
Fax | 954-759-6701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1700 NW 49TH ST STE 125
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33309-3763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-759-6988
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SVP/CFO
-----------------------------------------------------
Name | ALEXANDER FERNANDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-473-7642
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------