Healthcare Provider Details

I. General information

NPI: 1255283206
Provider Name (Legal Business Name): ARIEL BUSTAMANTE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 W 20TH AVE STE 105-106
HIALEAH FL
33016-1821
US

IV. Provider business mailing address

7600 W 20TH AVE STE 105-106
HIALEAH FL
33016-1821
US

V. Phone/Fax

Practice location:
  • Phone: 786-706-1028
  • Fax: 786-706-9028
Mailing address:
  • Phone: 786-706-1028
  • Fax: 786-706-9028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11045467
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11045467
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11045467
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number11045467
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: