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	291U00000X	Clinical Medical Laboratory	TPNU051	FL

General Provider Information

NPI Number	:	1770533390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA SOUTHEASTERN UNIVERSITY INC.

Provider Business Mailing Address
First Line	:	3200 S UNIVERSITY DR BLDG 3
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33328-2018
Country	:	US
Telephone Number	:	954-262-4343
Fax Number	:	954-262-3882

Provider Business Practice Location Address
First Line	:	3200 S UNIVERSITY DRIVE
Second Line	:	SANFORD L. ZIFF BLDG.
City	:	FT. LAUDERDALE
State	:	FL
Zip	:	33328-2018
Country	:	US
Telephone Number	:	954-262-7382
Fax Number	:	954-262-3882

Authorized Official
Title or Position	:	CONTRACTING AND CREDENTIALING DIREC
Name	:	MRS. ROSEMERY ESTEVEZ
Credential	:
Telephone Number	:	954-262-4343

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	05/04/2023

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