Provider Demographics
NPI:1770513681
Name:AL NISA INC
Entity type:Organization
Organization Name:AL NISA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JOSEFINA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:MUNAJJ
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP/CNM
Authorized Official - Phone:954-237-6409
Mailing Address - Street 1:3939 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6749
Mailing Address - Country:US
Mailing Address - Phone:954-237-6409
Mailing Address - Fax:954-272-6012
Practice Address - Street 1:3939 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 3B
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6749
Practice Address - Country:US
Practice Address - Phone:954-237-6409
Practice Address - Fax:954-272-6012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2589502363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty