Healthcare Provider Details

I. General information

NPI: 1134096399
Provider Name (Legal Business Name): IVAN PIMIENTA CONCEPCION APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6187 NW 167TH ST STE H34
HIALEAH FL
33015-4365
US

IV. Provider business mailing address

6187NW 167TH ST H34
HIALEAH FL
33015
US

V. Phone/Fax

Practice location:
  • Phone: 786-558-5657
  • Fax: 786-542-5722
Mailing address:
  • Phone: 786-558-5675
  • Fax: 786-542-5722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11043548
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number22-161
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11043548
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: