Provider Demographics
NPI:1043923865
Name:WASSERMAN, DARYL KEITH (APRN)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:KEITH
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11751 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33325-2911
Mailing Address - Country:US
Mailing Address - Phone:754-422-5930
Mailing Address - Fax:
Practice Address - Street 1:11751 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33325-2911
Practice Address - Country:US
Practice Address - Phone:754-422-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023601363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health