| South Broward Hospital District | |
|
3109 Stirling Rd Ste 101 Fort Lauderdale FL 33312-6558 | |
| (954) 276-1500 | |
| (954) 276-0700 |
| Full Name | South Broward Hospital District |
|---|---|
| Speciality | Internal Medicine |
| Location | 3109 Stirling Rd Ste 101, Fort Lauderdale, Florida |
| Authorized Official Name and Position | Esther Surujon (CFO MPG MPC & UCC) |
| Authorized Official Contact | 9542656677 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Broward Hospital District 2900 Corporate Way Door D Miramar FL 33025-3925 Ph: (954) 276-5685 | South Broward Hospital District 3109 Stirling Rd Ste 101 Fort Lauderdale FL 33312-6558 Ph: (954) 276-1500 |
| NPI Number | 1235955659 |
|---|---|
| Provider Enumeration Date | 12/02/2024 |
| Last Update Date | 12/02/2024 |
| Medicare PECOS PAC ID | 8123927373 |
|---|---|
| Medicare Enrollment ID | O20250313000510 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235955659 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Jessica Jacques |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689946493 PECOS PAC ID: 6103140892 Enrollment ID: I20160404000384 |
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