Healthcare Provider Details

I. General information

NPI: 1114439841
Provider Name (Legal Business Name): NELVA ROSA PUERTOLAS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5378 W 16TH AVE
HIALEAH FL
33012-2165
US

IV. Provider business mailing address

1000 NW 57TH CT STE 200
MIAMI FL
33126-3284
US

V. Phone/Fax

Practice location:
  • Phone: 305-820-4101
  • Fax: 305-820-2885
Mailing address:
  • Phone: 305-649-8100
  • Fax: 305-649-8778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN9294402
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9294402
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: