Healthcare Provider Details

I. General information

NPI: 1952930687
Provider Name (Legal Business Name): ALIETTE NEYRA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 SW 87TH AVE STE 10
MIAMI FL
33174-3245
US

IV. Provider business mailing address

4715 NW 157TH ST STE 119
MIAMI LAKES FL
33014-6408
US

V. Phone/Fax

Practice location:
  • Phone: 305-342-2481
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9502363
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11023132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: