Healthcare Provider Details

I. General information

NPI: 1972009066
Provider Name (Legal Business Name): WICKANDER FERREIRA BSN, RN, MLS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18031 BISCAYNE BLVD PH 2
AVENTURA FL
33160-5248
US

IV. Provider business mailing address

18031 BISCAYNE BLVD PH 2
AVENTURA FL
33160-5248
US

V. Phone/Fax

Practice location:
  • Phone: 305-704-8503
  • Fax:
Mailing address:
  • Phone: 305-704-8503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246QL0900X
TaxonomyLaboratory Management Specialist/Technologist
License NumberTN52623
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9674532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: