Provider Demographics
NPI:1972945202
Name:ERUCHALU, IFEOMA LILIAN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:IFEOMA
Middle Name:LILIAN
Last Name:ERUCHALU
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 NW 124TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3861
Mailing Address - Country:US
Mailing Address - Phone:954-239-8854
Mailing Address - Fax:954-239-8854
Practice Address - Street 1:3100 WESTON RD
Practice Address - Street 2:PRACTICE ADDRESS STANDARDIZATION
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3602
Practice Address - Country:US
Practice Address - Phone:954-689-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3141682363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care