Healthcare Provider Details

I. General information

NPI: 1114552478
Provider Name (Legal Business Name): ANNIA TABOADA CUZA APRN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 W 46TH ST APT 305
HIALEAH FL
33012-2815
US

IV. Provider business mailing address

1630 W 46TH ST APT 305
HIALEAH FL
33012-2815
US

V. Phone/Fax

Practice location:
  • Phone: 786-312-3515
  • Fax:
Mailing address:
  • Phone: 786-312-3515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11006429
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: