TRIDENT ANTI AGING LLC NPI 1023574696

NPI Information

TRIDENT ANTI AGING, LLC is a family medicine in Fort Lauderdale, FL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. TRIDENT ANTI AGING, LLC NPI is 1023574696. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Trident Primary & Preventative Care.

The provider's business location address is:

800 E BROWARD BLVD STE 400
FORT LAUDERDALE, FL
ZIP 33301-033
Phone: (954) 451-5454

The provider's authorized official is John Poulos .
The authorized official title is Owner and has the following contact phone number (954) 451-5454.

The CLIA number assigned to this NPI record is 10D2163812 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/19/2019 and was last updated on 8/26/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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