Provider Demographics
NPI:1720126584
Name:NOVA SOUTHEASTERN UNIVERSITY, INC.
Entity Type:Organization
Organization Name:NOVA SOUTHEASTERN UNIVERSITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF CONTRACTING AND CREDEN
Authorized Official - Prefix:
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 1:3200 S UNIVERSITY DR
Mailing Address - Street 2:SANFORD L. ZIFF BLDG, 3RD FLOOR, ROOM 4364-D
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-2018
Mailing Address - Country:US
Mailing Address - Phone:954-262-4343
Mailing Address - Fax:954-262-1172
Practice Address - Street 1:3301 COLLEGE AVE
Practice Address - Street 2:UNIVERSITY CENTER ROOM 1433
Practice Address - City:FT. LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33314-7721
Practice Address - Country:US
Practice Address - Phone:954-262-5590
Practice Address - Fax:954-262-5570
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:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL98673OtherMEDICARE GROUP NUMBER
FL98673OtherMEDICARE GROUP NUMBER