Healthcare Provider Details

I. General information

NPI: 1306095872
Provider Name (Legal Business Name): ANISLEY AGUILA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12460 SW 8TH ST SUITE#204
MIAMI FL
33184-1437
US

IV. Provider business mailing address

12460 SW 8TH ST SUITE#204
MIAMI FL
33184-1437
US

V. Phone/Fax

Practice location:
  • Phone: 305-553-0334
  • Fax: 305-553-0336
Mailing address:
  • Phone: 305-553-0334
  • Fax: 305-553-0336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number299993281
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: