MEDICARE: NURSE PRACTITIONER ON DEMAND 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1972128379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NURSE PRACTITIONER ON DEMAND LLC

Provider Business Mailing Address
First Line	:	6801 NW 46TH CT
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-4024
Country	:	US
Telephone Number	:	954-297-0740
Fax Number	:

Provider Business Practice Location Address
First Line	:	1491 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304
Country	:	US
Telephone Number	:	954-297-0740
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NADINE NORDEAN MCFARLANE
Credential	:	MSN, FNP- BC
Telephone Number	:	954-297-0740

Provider Enumeration Date	:	06/11/2020
Last Update Date	:	06/11/2020

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