THE DIABETIC PLACE LLC NPI 1104022169

NPI Information

NPI: 1104022169
Provider Name: THE DIABETIC PLACE LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

Address:
10472 TAFT ST
PEMBROKE PINES, FL
ZIP 33026
Phone: (954) 990-0461
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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
1	363LF0000X	Nurse Practitioner	Family	1956772	FLORIDA	Yes

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
1	281108100	MEDICAID	FLORIDA
2	AF948	MEDICARE UPIN	FLORIDA

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: 11/14/2023

NPI Synchronization or Removal

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