Provider Demographics
NPI:1265999585
Name:GANGADEEN, JUMA (FNP-C)
Entity type:Individual
Prefix:
First Name:JUMA
Middle Name:
Last Name:GANGADEEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7331 NW 48TH CT
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-3422
Mailing Address - Country:US
Mailing Address - Phone:305-215-4762
Mailing Address - Fax:
Practice Address - Street 1:2500 E COMMERCIAL BLVD STE D
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4124
Practice Address - Country:US
Practice Address - Phone:954-909-5708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9201236363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily