NPIMap

Organization Active NPI

Nova Southeastern University, Inc

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Fort Lauderdale, FL
National Provider Identifier
1093442824
Registry record updated Sep 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
Legal business name
NOVA SOUTHEASTERN UNIVERSITY, INC
Practice address
1625 SE 3Rd Ave Ste 802
Ft Lauderdale, FL 33316-2521
Phone
(954) 262-7500
NPI assigned
Aug 2, 2022
Last updated
Sep 29, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
NOVA SOUTHEASTERN UNIVERSITY, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 29, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Julissa Lazala
Title
Director of Revenue Cycle
Phone
(954) 262-4946

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X Primary

Addresses

Primary practice location

1625 SE 3Rd Ave Ste 802
Ft Lauderdale, FL 33316-2521

Mailing address

PO Box 290370
Davie, FL 33329-0370
Phone (954) 262-4343

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Nextgen

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031118000987 FL Part B Supplier - Clinic/Group Practice 4486568896 Receives reassigned benefits from 259 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Davie, FL; Wilton Manors, FL; Sunrise, FL; Plantation, FL; North Miami Beach, FL; Miami, FL; Ft Lauderdale, FL; Fort Lauderdale, FL

Other NPIs on the same Medicare enrollment 22

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 22

National Provider Directory

National Provider Directory
Tax ID family
Nova Southeastern Unive38 organizations share this tax ID, including this one
Part of
Nova Southeastern Unive

Other organizations with this tax ID 37

Organizations that report the same tax identification number in the National Provider Directory.

View all 37

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1659398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790640000000",
    "number": "1093442824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290370",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333290370",
            "telephone_number": "954-262-4343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 SE 3RD AVE STE 802",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162521",
            "telephone_number": "954-262-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVA SOUTHEASTERN UNIVERSITY, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NOVA SOUTHEASTERN UNIVERSITY, INC",
        "enumeration_date": "2022-08-02",
        "last_updated": "2026-09-29",
        "certification_date": "2026-09-29",
        "status": "A",
        "authorized_official_last_name": "LAZALA",
        "authorized_official_first_name": "JULISSA",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "954-262-4946"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Nextgen",
            "affiliation": "N",
            "address_1": "1625 SE 3rd Ave Ste 802",
            "city": "Ft Lauderdale",
            "state": "FL",
            "country_code": "US",
            "postal_code": "333162521",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.