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General NPI Number Information
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NPI Number | 1891540779
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Entity Type | Individual
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Provider Name | OTELIAH ANN MARIE CARTER SHERWOOD
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Gender | Female
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Dates
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Enumeration Date | 04/23/2024
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 4890 N STATE ROAD 7
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City | COCONUT CREEK
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State | FL
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Zip | 33073-3303
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Country | US
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Telephone | 954-379-3528
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Fax |
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Provider Business Mailing Address
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Address Line | 5368 MACOON WAY
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City | WESTLAKE
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State | FL
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Zip | 33470-7059
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Country | US
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Telephone | 954-394-0705
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11032318
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License Number State | FL
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