Healthcare Provider Details

I. General information

NPI: 1194459388
Provider Name (Legal Business Name): MARIAM S. URDANETA ARNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 S FEDERAL HWY
BOCA RATON FL
33432-4805
US

IV. Provider business mailing address

413 E PALMETTO PARK RD APT 455
BOCA RATON FL
33432-5186
US

V. Phone/Fax

Practice location:
  • Phone: 786-515-4559
  • Fax:
Mailing address:
  • Phone: 786-515-4559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number9521113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: