MEDICARE: PLANTATION DIABETES & METABOLISM CLINIC, 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

General Provider Information

NPI Number	:	1952342461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLANTATION DIABETES & METABOLISM CLINIC, LLC

Provider Business Mailing Address
First Line	:	4101 NW 4TH ST
Second Line	:	SUITE 211
City	:	PLANTATION
State	:	FL
Zip	:	33317-2850
Country	:	US
Telephone Number	:	954-236-8338
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 NW 4TH ST
Second Line	:	SUITE 211
City	:	PLANTATION
State	:	FL
Zip	:	33317-2850
Country	:	US
Telephone Number	:	954-236-8338
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	ROBERT ENGLAND
Credential	:
Telephone Number	:	954-236-8338

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	08/22/2020

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