1801102751 NPI number — MS. PHYLLIS DENISE PARE ARNP

Table of content: MS. PHYLLIS DENISE PARE ARNP (NPI 1801102751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801102751 NPI number — MS. PHYLLIS DENISE PARE ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARE
Provider First Name:
PHYLLIS
Provider Middle Name:
DENISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801102751
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 W HILLSBORO BLVD
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
DEERFIELD BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33441-1609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-448-7716
Provider Business Mailing Address Fax Number:
954-596-4746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 W HILLSBORO BLVD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
DEERFIELD BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33441-1609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-448-7716
Provider Business Practice Location Address Fax Number:
954-596-4746
Provider Enumeration Date:
08/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  ARNP 2018452 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100304700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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