Provider Demographics
NPI:1407260375
Name:VASILIADI-BROIT, ALIKI (ARNP)
Entity Type:Individual
Prefix:
First Name:ALIKI
Middle Name:
Last Name:VASILIADI-BROIT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:954-430-9300
Mailing Address - Fax:954-450-2833
Practice Address - Street 1:18425 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1415
Practice Address - Country:US
Practice Address - Phone:954-430-9300
Practice Address - Fax:954-450-2883
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9272762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018602800Medicaid