Provider Demographics
NPI:1700924511
Name:NOVA SOUTHEASTERN UNIVERSITY, INC
Entity Type:Organization
Organization Name:NOVA SOUTHEASTERN UNIVERSITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEMERY
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTEVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-262-4343
Mailing Address - Street 1:PO BOX 290370
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33329-0370
Mailing Address - Country:US
Mailing Address - Phone:954-262-4397
Mailing Address - Fax:954-262-2269
Practice Address - Street 1:650 NORTH ANDREWS AVENUE
Practice Address - Street 2:
Practice Address - City:FT. LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-7436
Practice Address - Country:US
Practice Address - Phone:954-262-4100
Practice Address - Fax:954-262-6888
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOVA SOUTHEASTERN UNIVERSITY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-02
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078488503Medicaid
FL98673OtherMEDICARE