THE DIABETIC PLACE LLC NPI 1104022169

NPI Information

  • NPI: 1104022169
  • Provider Name: THE DIABETIC PLACE LLC
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Organization
  • Address: 10472 TAFT ST
    PEMBROKE PINES, FL
    ZIP 33026
  • Phone: (954) 990-0461

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NPI Details

THE DIABETIC PLACE LLC is a family nurse practitioner in Pembroke Pines, FL. THE DIABETIC PLACE LLC NPI is 1104022169. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

10472 TAFT ST
PEMBROKE PINES, FL
ZIP 33026-819
Phone: (954) 990-0461
Fax: (954) 990-0465

The provider's authorized official is Shawna Charles .
The authorized official title is Nurse Practitioner and has the following contact phone number (954) 990-0461.

The enumeration date for this NPI number is 6/26/2007 and was last updated on 3/30/2015.

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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamily1956772FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1281108100MEDICAIDFLORIDA
2AF948MEDICARE UPINFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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