Healthcare Provider Details

I. General information

NPI: 1851726517
Provider Name (Legal Business Name): NIURKA M FERNANDEZ BLANCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12821 SW 43RD DR APT 131
MIAMI FL
33175-4180
US

IV. Provider business mailing address

12821 SW 43RD DR APT 131
MIAMI FL
33175-4180
US

V. Phone/Fax

Practice location:
  • Phone: 305-796-1021
  • Fax: 305-223-8399
Mailing address:
  • Phone: 786-320-2955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberCNA187412
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: