MEDICARE: MRS. SVETLANA SEREBRYANAYA NP

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	219330	AZ
2	363LF0000X	Family Nurse Practitioner	11017974	FL

General Provider Information

NPI Number	:	1952870628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SVETLANA SEREBRYANAYA NP

Provider Business Mailing Address
First Line	:	3940 W BROWARD BLVD APT 108
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-1071
Country	:	US
Telephone Number	:	323-854-4965
Fax Number	:

Provider Business Practice Location Address
First Line	:	3940 W BROWARD BLVD APT 108
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-1071
Country	:	US
Telephone Number	:	323-854-4965
Fax Number	:

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

Provider Enumeration Date	:	11/24/2018
Last Update Date	:	05/02/2022

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