MEDICARE: AP OF BROWARD, LLC

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	363L00000X	Nurse Practitioner
2	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1427449081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AP OF BROWARD, LLC

Provider Business Mailing Address
First Line	:	4220 WALLACE LN
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-3232
Country	:	US
Telephone Number	:	954-292-8657
Fax Number	:

Provider Business Practice Location Address
First Line	:	3981 SW 30TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6816
Country	:	US
Telephone Number	:	954-292-8657
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. JOHN TOBIAS GRAY
Credential	:
Telephone Number	:	954-292-8657

Provider Enumeration Date	:	02/18/2015
Last Update Date	:	02/18/2015

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