MEDICARE: KYLE JORDAN AVEIGA 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	363L00000X	Nurse Practitioner	APRN11033066	FL
2	363LF0000X	Family Nurse Practitioner	APRN11033066	FL

General Provider Information

NPI Number	:	1942044037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE JORDAN AVEIGA APRN

Provider Business Mailing Address
First Line	:	2672 W 72ND ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-5419
Country	:	US
Telephone Number	:	305-338-8163
Fax Number	:

Provider Business Practice Location Address
First Line	:	2672 W 72ND ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-5419
Country	:	US
Telephone Number	:	305-338-8163
Fax Number	:

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

Provider Enumeration Date	:	06/24/2024
Last Update Date	:	11/08/2024

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