MEDICARE: DEMIS JAVIER REY ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP9351637	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366984551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEMIS JAVIER REY ARNP

Provider Business Mailing Address
First Line	:	11461 SW 42ND TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4620
Country	:	US
Telephone Number	:	786-439-5657
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 W 49TH ST STE 450
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3487
Country	:	US
Telephone Number	:	305-560-4995
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2016
Last Update Date	:	07/12/2021

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Directions to “ DEMIS JAVIER REY ARNP” Practice Location

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