# ADVANCE PRACTICE/FINE FOR NO REASSON

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700450632
- **Authorized official:** DR. SHIRLEY MOISE DNP (DOCTOR OF NURSING PRACTICE)
- **Authorized official phone:** (954) 834-3669

## Contact information

- **Practice address:** 11600 NW 18TH ST, PEMBROKE PINES, FL 33026-2057
- **Practice address phone:** (954) 834-3669
- **Mailing address:** 11600 NW 18TH ST, PEMBROKE PINES, FL 33026-2057
- **Mailing address phone:** (954) 834-3669

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 251J00000X | Nursing Care Agency | — | NULL | — |
| 302R00000X | Health Maintenance Organization | — | NULL | — |

## Other

- **Enumeration date:** 05/15/2021
- **Last updated:** 05/15/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0163704-00 | — | FL |