Provider Demographics
NPI:1255812962
Name:NODARSE, OVI (APRN)
Entity type:Individual
Prefix:
First Name:OVI
Middle Name:
Last Name:NODARSE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 BONAVENTURE BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-4039
Mailing Address - Country:US
Mailing Address - Phone:954-656-3181
Mailing Address - Fax:954-656-3188
Practice Address - Street 1:1751 BONAVENTURE BLVD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-4039
Practice Address - Country:US
Practice Address - Phone:954-656-3181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9376506363LF0000X
FLAPRN9376506363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily