Provider Demographics
NPI:1881340248
Name:FLORES, DIVINE DABU (RN)
Entity type:Individual
Prefix:
First Name:DIVINE
Middle Name:DABU
Last Name:FLORES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NORJELINN ROSE
Other - Middle Name:
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:811 CYPRESS GROVE LN
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-5006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12127 NW 9TH DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-5014
Practice Address - Country:US
Practice Address - Phone:817-933-7363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-24
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9551860163W00000X
FL149239367500000X
FLAPRN11032962367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse