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Provider Information for 1013503762

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1013503762

Calendar   Last Updated:  2020-12-16
  Certification Date:  2020-12-16


Name Value
NPI 1013503762
Enumeration Date 2020-12-16
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 11750 NE 16TH AVE APT 209
NORTH MIAMI, FL 33161-6929
United States

Phone: 786-385-4492 | Fax: 305-673-4840
View Map External Link
Primary Practice Address 1989 CITRINE WAY
SANTA ROSA, CA 95404-7012
United States

Phone: 786-385-4492 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 363LF0000X - Nurse Practitioner Family FL 11006625
No 363LF0000X - Nurse Practitioner Family CA 95015461