Provider Demographics
NPI:1396094090
Name:RAINFOREST FAMILY MEDICAL
Entity type:Organization
Organization Name:RAINFOREST FAMILY MEDICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTANZO
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-717-8778
Mailing Address - Street 1:4699 N STATE ROAD 7
Mailing Address - Street 2:STE B2
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5879
Mailing Address - Country:US
Mailing Address - Phone:954-717-8778
Mailing Address - Fax:
Practice Address - Street 1:4699 N STATE ROAD 7
Practice Address - Street 2:STE B2
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5879
Practice Address - Country:US
Practice Address - Phone:954-717-8778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 787612261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service