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Organization
NOVA SOUTHEASTERN UNIVERSITY, INC
Active
Organization
NOVA SOUTHEASTERN UNIVERSITY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSEMERY ESTEVEZ (CREDENTIALING AND CONTRACTING DIR)
(954) 262-4343
Entity
Organization
Contact information
Practice address
3625 COLLEGE AVE STE 135, DAVIE, FL 33314-7724
(954) 262-4100
Mailing address
PO BOX 290370, DAVIE, FL 33329-0370
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59-1083502
TAX ID
FL
Enumeration date
12/02/2020
Last updated
12/02/2020
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