MEDICARE: NOVA SOUTHEASTERN UNIVERSITY, INC

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	156FX1800X	Optician
2	152W00000X	Optometrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	98673	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700924511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA SOUTHEASTERN UNIVERSITY, INC

Provider Business Mailing Address
First Line	:	PO BOX 290370
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33329-0370
Country	:	US
Telephone Number	:	954-262-4397
Fax Number	:	954-262-2269

Provider Business Practice Location Address
First Line	:	650 NORTH ANDREWS AVENUE
Second Line	:
City	:	FT. LAUDERDALE
State	:	FL
Zip	:	33311-7436
Country	:	US
Telephone Number	:	954-262-4100
Fax Number	:	954-262-6888

Authorized Official
Title or Position	:	CONTRACTING DIRECTOR
Name	:	DR. ROSEMERY ESTEVEZ
Credential	:
Telephone Number	:	954-262-4343

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	02/19/2024

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