Individual
PETRINE FARDETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
3000 BAYVIEW DR, FORT LAUDERDALE, FL 33306-1772
(954) 567-1332
(954) 537-7705
Mailing address
3000 BAYVIEW DR, FORT LAUDERDALE, FL 33306-1772
(954) 567-1332
(954) 537-7705
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
ME0044395
FL
363AS0400X
Surgical Physician Assistant
Primary
PA3368
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290935900
—
FL
Enumeration date
07/24/2006
Last updated
10/08/2019
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