Provider Demographics
NPI:1952990103
Name:NOFAL, NADINE JAMAL
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:JAMAL
Last Name:NOFAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11020 SW 25TH CT APT 7305
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7648
Mailing Address - Country:US
Mailing Address - Phone:330-840-1339
Mailing Address - Fax:
Practice Address - Street 1:11020 SW 25TH CT APT 7305
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-7648
Practice Address - Country:US
Practice Address - Phone:330-840-1339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21410225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist