Provider Demographics
NPI:1205870185
Name:PEARLMUTTER, NINA JOY (MD)
Entity type:Individual
Prefix:MS
First Name:NINA
Middle Name:JOY
Last Name:PEARLMUTTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SW 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15814 WEST STATE ROAD 84
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33326
Practice Address - Country:US
Practice Address - Phone:954-384-7200
Practice Address - Fax:954-389-9019
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME034447207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
160624900OtherUS DEPT OF LABOR
FL065825100Medicaid
FL065825100Medicaid
160624900OtherUS DEPT OF LABOR