Healthcare Provider Details

I. General information

NPI: 1851983316
Provider Name (Legal Business Name): DECIRE ESPINOZA DE MENDOZA APRN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 DAVIE BLVD
FT LAUDERDALE FL
33312-3440
US

IV. Provider business mailing address

3690 DAVIE BLVD
FT LAUDERDALE FL
33312-3440
US

V. Phone/Fax

Practice location:
  • Phone: 305-266-2929
  • Fax:
Mailing address:
  • Phone: 305-266-2929
  • Fax: 786-377-5561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11011483
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: