Provider Demographics
NPI:1558497370
Name:KIDS KLINIC, BROWARD CHILDREN CENTER
Entity Type:Organization
Organization Name:KIDS KLINIC, BROWARD CHILDREN CENTER
Other - Org Name:COASTAL KIDS
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-933-0597
Mailing Address - Street 1:114 SE 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7547
Mailing Address - Country:US
Mailing Address - Phone:954-933-0597
Mailing Address - Fax:954-941-1164
Practice Address - Street 1:1055 SW 44TH AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-4535
Practice Address - Country:US
Practice Address - Phone:954-584-7205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1830552261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care