NPIMap

Organization Active NPI

The Diabetic Place LLC

  • Family Nurse Practitioner
  • Pembroke Pines, FL
National Provider Identifier
1104022169
Registry record updated Mar 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1956772 Issued in FL
Legal business name
THE DIABETIC PLACE LLC
Practice address
10472 Taft St
Pembroke Pines, FL 33026-2819
Phone
(954) 990-0461
Fax
(954) 990-0465
NPI assigned
Jun 26, 2007
Last updated
Mar 30, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2015

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

Authorized official

Name
Dr. Shawna Charles, DNPNPI 1851428064
Title
Nurse Practitioner
Phone
(954) 990-0461

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X 1956772 FL Primary

Addresses

Primary practice location

10472 Taft St
Pembroke Pines, FL 33026-2819

Mailing address

PO Box 848182
Hollywood, FL 33084-0182
Phone (954) 990-0461

National Provider Directory

National Provider Directory

Locations

16799 NE 1st Ave
North Miami Beach, FL 33162
Phone (305) 652-3424

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427673600000",
    "number": "1104022169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 848182",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330840182",
            "telephone_number": "954-990-0461",
            "fax_number": "954-990-0465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10472 TAFT ST",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330262819",
            "telephone_number": "954-990-0461",
            "fax_number": "954-990-0465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DIABETIC PLACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-26",
        "last_updated": "2015-03-30",
        "status": "A",
        "authorized_official_last_name": "CHARLES",
        "authorized_official_first_name": "SHAWNA",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "954-990-0461",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "1956772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.