=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902589435
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PALM TREES NURSING REGISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2023
-----------------------------------------------------
Last Update Date | 08/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2981 HIBISCUS AVE
-----------------------------------------------------
City | OAKLAND PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33311-1189
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-630-6617
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2981 HIBISCUS AVE
-----------------------------------------------------
City | OAKLAND PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33311-1189
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-630-6617
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING OWNER
-----------------------------------------------------
Name | MR. MOHAMED YAKOUT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-424-9489
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------