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General NPI Number Information
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NPI Number | 1972688992
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Entity Type | Organization
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Legal Business Name | BOARD OF TRUSTEES OF FLORIDA ATLANTIC UNIVERSITY
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 04/15/2023
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Provider Practice Location Address
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Address Line | 777 GLADES RD STUDENT HEALTH, BLDG SS-8W, ROOM 235
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City | BOCA RATON
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State | FL
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Zip | 33431-0991
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Country | US
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Telephone | 561-297-0704
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Fax | 561-297-0221
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Provider Business Mailing Address
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Address Line | 777 GLADES RD STUDENT HEALTH, BLDG SS-8W, ROOM 235
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City | BOCA RATON
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State | FL
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Zip | 33431-6424
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Country | US
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Telephone | 561-297-0704
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Fax | 561-297-0221
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | LOUISA PONTIROLI-KELLY
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Credential |
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Telephone | 561-297-2897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number | NOT REQUIRED
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License Number State | FL
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