Basic Information
| Provider Information | |||||||||
| NPI: | 1467876698 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERKOWITZ | ||||||||
| FirstName: | RANDI | ||||||||
| MiddleName: | RACHEL | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1815 GRIFFIN RD STE 204 | ||||||||
| Address2: | |||||||||
| City: | DANIA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330042252 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1815 GRIFFIN RD STE 204 | ||||||||
| Address2: | |||||||||
| City: | DANIA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330042252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546247900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2014 | ||||||||
| LastUpdateDate: | 02/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN9498902 | FL | N | Nursing Service Providers | Registered Nurse | 163W00000X | 595201 | NY | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 338487 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | AC002586 | MD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | APRN11000223 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.