Healthcare Provider Details

I. General information

NPI: 1083296602
Provider Name (Legal Business Name): LARA MICAELA VARGAS ALVAREZ CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 SW ARCHER RD
GAINESVILLE FL
32608-1316
US

IV. Provider business mailing address

920 SW 6TH ST APT 311
GAINESVILLE FL
32601-2600
US

V. Phone/Fax

Practice location:
  • Phone: 352-554-2000
  • Fax:
Mailing address:
  • Phone: 904-525-7132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA400772
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: