Healthcare Provider Details

I. General information

NPI: 1861180119
Provider Name (Legal Business Name): ANDRENY HURTADO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W 54TH ST APT 113
HIALEAH FL
33012-2148
US

IV. Provider business mailing address

1800 W 54TH ST APT 113
HIALEAH FL
33012-2148
US

V. Phone/Fax

Practice location:
  • Phone: 786-580-6546
  • Fax:
Mailing address:
  • Phone: 786-580-6546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF02230614
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: