Provider Demographics
NPI:1942501697
Name:AZAM, ADELLE M (ARNP)
Entity Type:Individual
Prefix:
First Name:ADELLE
Middle Name:M
Last Name:AZAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ADELLE
Other - Middle Name:M
Other - Last Name:AZAM-BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-320-2640
Mailing Address - Fax:954-320-2610
Practice Address - Street 1:3100 CORAL HILLS DR STE 202
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4139
Practice Address - Country:US
Practice Address - Phone:954-320-2640
Practice Address - Fax:954-320-2610
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3261052163WE0003X, 163WM0705X, 363L00000X, 363LF0000X
ZZARNP 3261052163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000445400Medicaid
FLARNP3261052OtherFL LICENSE
FL000445400Medicaid