Healthcare Provider Details

I. General information

NPI: 1619665395
Provider Name (Legal Business Name): LUANDA ALICIA PINO OLIVEROS APRN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 HOMESTEAD RD N STE 102
LEHIGH ACRES FL
33936-6049
US

IV. Provider business mailing address

740 MILWAUKEE BLVD
LEHIGH ACRES FL
33974-9570
US

V. Phone/Fax

Practice location:
  • Phone: 239-303-2700
  • Fax:
Mailing address:
  • Phone: 786-585-6567
  • Fax: 239-303-2756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11025768
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: