Provider Demographics
NPI:1841999588
Name:VARGHESE, BOBBY (PHD, APRN, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:M
Credentials:PHD, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 NW 150TH AVE STE 290
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2886
Mailing Address - Country:US
Mailing Address - Phone:954-228-7856
Mailing Address - Fax:
Practice Address - Street 1:1931 NW 150TH AVE STE 290
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2886
Practice Address - Country:US
Practice Address - Phone:954-228-7856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11024475363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health