Healthcare Provider Details

I. General information

NPI: 1285148627
Provider Name (Legal Business Name): ELIER TINOCO APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 W PALM DR
FLORIDA CITY FL
33034-3223
US

IV. Provider business mailing address

6100 BLUE LAGOON DR STE 365
MIAMI FL
33126-7010
US

V. Phone/Fax

Practice location:
  • Phone: 786-279-0764
  • Fax: 786-245-8019
Mailing address:
  • Phone: 786-322-7333
  • Fax: 786-322-7329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9428804
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: