Provider Demographics
NPI:1598820623
Name:HAQ, AMENA NUZHAT (MD)
Entity Type:Individual
Prefix:DR
First Name:AMENA
Middle Name:NUZHAT
Last Name:HAQ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4845 COCONUT CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-3944
Mailing Address - Country:US
Mailing Address - Phone:954-968-2955
Mailing Address - Fax:954-968-8559
Practice Address - Street 1:4845 COCONUT CREEK PKWY
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-3944
Practice Address - Country:US
Practice Address - Phone:954-968-2955
Practice Address - Fax:954-968-8559
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047993207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBH0715485OtherDEA
FL94481Medicare ID - Type UnspecifiedPROVIDER ID
FLD86509Medicare UPIN