MEDICARE: NORTH BROWARD HOSPITAL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1023965944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH BROWARD HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	1608 SE 3RD AVE FL 3
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2564
Country	:	US
Telephone Number	:	954-958-5250
Fax Number	:	954-958-5251

Provider Business Practice Location Address
First Line	:	2611 E OAKLAND PARK BLVD STE 310
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1602
Country	:	US
Telephone Number	:	954-958-5250
Fax Number	:	954-958-5251

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	KRYSTLE MARTIN
Credential	:
Telephone Number	:	954-473-7420

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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