Healthcare Provider Details

I. General information

NPI: 1437038809
Provider Name (Legal Business Name): JUANA SOTOLONGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18425 NW 2ND AVE PH 5
MIAMI GARDENS FL
33169-4524
US

IV. Provider business mailing address

18425 NW 2ND AVE PH 5
MIAMI GARDENS FL
33169-4524
US

V. Phone/Fax

Practice location:
  • Phone: 800-434-1366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11041822
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number9624010
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: