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Provider Information for 1992275200

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: 1992275200

Calendar   Last Updated:  2020-03-02
  Certification Date:  2020-03-02


Name Value
NPI 1992275200
Enumeration Date 2018-11-29
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 14629 SW 95TH LN
MIAMI, FL 33186-1041
United States

Phone: 786-315-1781 | Fax:
View Map External Link
Primary Practice Address 1400 NW 12TH AVE
MIAMI, FL 33136-1003
United States

Phone: 786-266-1883 | 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 APRN11000158