Divine Healthcare Service Corp

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1691672 Issued in FL

Legal business name

DIVINE HEALTHCARE SERVICE CORP

Practice address

15883 NW 11TH St
Pembroke Pines, FL 33028

Phone

(954) 559-6045

Fax

(954) 450-7975

NPI assigned

Oct 30, 2017

Last updated

Oct 30, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Marie Edith Maloku, ARNP

Title

NP

Phone

(954) 559-6045

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1509321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1509321600000",
    "number": "1992217061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15883 NW 11TH ST",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330281602",
            "telephone_number": "954-559-6045",
            "fax_number": "954-450-7975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15883 NW 11TH ST",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "33028",
            "telephone_number": "954-559-6045",
            "fax_number": "954-450-7975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE HEALTHCARE SERVICE CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-30",
        "last_updated": "2017-10-30",
        "status": "A",
        "authorized_official_last_name": "MALOKU",
        "authorized_official_first_name": "MARIE",
        "authorized_official_middle_name": "EDITH",
        "authorized_official_title_or_position": "NP",
        "authorized_official_telephone_number": "954-559-6045",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "1691672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Pembroke Pines, FL
• Providers in Pembroke Pines, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2017; 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.