MEDICARE: IVAN GARCIA ALONSO APRN

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	APRN11004667	FL

General Provider Information

NPI Number	:	1417590860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVAN GARCIA ALONSO APRN

Provider Business Mailing Address
First Line	:	1300 SW 122ND AVE
Second Line	:	APT 111CA
City	:	MIAMI
State	:	FL
Zip	:	33184-2815
Country	:	US
Telephone Number	:	786-975-8763
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 SW 122ND AVE
Second Line	:	APT 111CA
City	:	MIAMI
State	:	FL
Zip	:	33184-2815
Country	:	US
Telephone Number	:	786-975-8763
Fax Number	:

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

Provider Enumeration Date	:	10/17/2019
Last Update Date	:	02/21/2021

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