Healthcare Provider Details

I. General information

NPI: 1184456535
Provider Name (Legal Business Name): KARINA MARIE OQUENDO CUEVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16332 CORTEZ BLVD
BROOKSVILLE FL
34601-8980
US

IV. Provider business mailing address

30375 LARIMAR LN
WESLEY CHAPEL FL
33545-4460
US

V. Phone/Fax

Practice location:
  • Phone: 813-921-0389
  • Fax:
Mailing address:
  • Phone: 813-495-2796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11034679
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: