Provider Demographics
NPI:1780337329
Name:PAULETTE GOPMAN PERLOWIN LLC
Entity type:Organization
Organization Name:PAULETTE GOPMAN PERLOWIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:G
Authorized Official - Last Name:PERLOWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,PMHNP,ANP,APRNBC
Authorized Official - Phone:954-471-2801
Mailing Address - Street 1:4291 NW 1ST DR
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-9245
Mailing Address - Country:US
Mailing Address - Phone:954-471-2801
Mailing Address - Fax:954-531-1708
Practice Address - Street 1:4291 NW 1ST DR
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9245
Practice Address - Country:US
Practice Address - Phone:954-471-2801
Practice Address - Fax:954-531-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768217400Medicaid
1639230899OtherINDIVIDUAL NPI