Healthcare Provider Details

I. General information

NPI: 1851021950
Provider Name (Legal Business Name): MIRIAM RUSINDO BERMUDEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 VISCAYA PKWY STE 2
CAPE CORAL FL
33990-6200
US

IV. Provider business mailing address

3101 42ND TER SW
NAPLES FL
34116-8352
US

V. Phone/Fax

Practice location:
  • Phone: 239-772-0111
  • Fax: 239-772-0267
Mailing address:
  • Phone: 239-307-9304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11019319
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: