Provider Demographics
NPI:1083015440
Name:EDELMAN, NINA (ARNP)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:EDELMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-320-3360
Mailing Address - Fax:954-473-2327
Practice Address - Street 1:1926 HOLLYWOOD BLVD STE 304
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4543
Practice Address - Country:US
Practice Address - Phone:754-778-8238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9264383363LP0808X
FLARNP9264383363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty