Provider Demographics
NPI:1215321617
Name:NST FAMILY
Entity type:Organization
Organization Name:NST FAMILY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-474-4401
Mailing Address - Street 1:600 SOUTH PINE ISLAND ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324
Mailing Address - Country:US
Mailing Address - Phone:954-474-4401
Mailing Address - Fax:
Practice Address - Street 1:600 S PINE ISLAND RD
Practice Address - Street 2:SUITE 104
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3166
Practice Address - Country:US
Practice Address - Phone:954-474-4401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBM785ZMedicare PIN