Provider Demographics
NPI:1700450632
Name:ADVANCE PRACTICE/FINE FOR NO REASSON
Entity Type:Organization
Organization Name:ADVANCE PRACTICE/FINE FOR NO REASSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF NURSING PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOISE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:954-834-3669
Mailing Address - Street 1:11600 NW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-2057
Mailing Address - Country:US
Mailing Address - Phone:954-834-3669
Mailing Address - Fax:
Practice Address - Street 1:11600 NW 18TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-2057
Practice Address - Country:US
Practice Address - Phone:954-834-3669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-15
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No251J00000XAgenciesNursing Care
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0163704-00Medicaid