MEDICARE: DARYL KEITH WASSERMAN APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11023601	FL

General Provider Information

NPI Number	:	1043923865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARYL KEITH WASSERMAN APRN

Provider Business Mailing Address
First Line	:	11751 SW 3RD ST
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33325-2911
Country	:	US
Telephone Number	:	754-422-5930
Fax Number	:

Provider Business Practice Location Address
First Line	:	11751 SW 3RD ST
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33325-2911
Country	:	US
Telephone Number	:	754-422-5930
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2022
Last Update Date	:	03/13/2023

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