Provider Demographics
NPI:1861844227
Name:NANCY PYRAM-BERNARD DO LLC LICE SOURCE SERVICES & SFFHRC
Entity Type:Organization
Organization Name:NANCY PYRAM-BERNARD DO LLC LICE SOURCE SERVICES & SFFHRC
Other - Org Name:SOUTH FLORIDA FAMILY HEALTH AND RESEARCH CENTER PLANTATION AND LICE S
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-791-0711
Mailing Address - Street 1:6971 W SUNRISE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313-4407
Mailing Address - Country:US
Mailing Address - Phone:954-791-0711
Mailing Address - Fax:954-791-4392
Practice Address - Street 1:6971 W SUNRISE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-4407
Practice Address - Country:US
Practice Address - Phone:954-791-0711
Practice Address - Fax:954-791-4392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care