Basic Information
| Provider Information | |||||||||
| NPI: | 1043520091 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AHP OF SOUTH BROWARD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3079 PEACHTREE INDUSTRIAL BLVD | ||||||||
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| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300972215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709455330 | ||||||||
| FaxNumber: | 6785463606 | ||||||||
| Practice Location | |||||||||
| Address1: | 11011 SHERIDAN ST | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330261505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6454350101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2010 | ||||||||
| LastUpdateDate: | 02/17/2011 | ||||||||
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| AuthorizedOfficialLastName: | BLASETTI | ||||||||
| AuthorizedOfficialFirstName: | ALLISON | ||||||||
| AuthorizedOfficialMiddleName: | ROSE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR CREDENTIALING & ENROLLMENT | ||||||||
| AuthorizedOfficialTelephone: | 7709455330 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.