Provider Demographics
NPI:1821650862
Name:LEE, DAVID (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 N FEDERAL HWY APT 1602
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2183
Mailing Address - Country:US
Mailing Address - Phone:321-961-5136
Mailing Address - Fax:
Practice Address - Street 1:5966 S DIXIE HWY STE 401
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5177
Practice Address - Country:US
Practice Address - Phone:786-886-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-30
Last Update Date:2019-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11002754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily