Healthcare Provider Details

I. General information

NPI: 1023939329
Provider Name (Legal Business Name): ALEXANDRA BIBIANA TRONCOSO CALVO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W 79TH ST
HIALEAH FL
33014-3589
US

IV. Provider business mailing address

1100 W 79TH ST
HIALEAH FL
33014-3589
US

V. Phone/Fax

Practice location:
  • Phone: 786-449-1376
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11048686
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: