Healthcare Provider Details

I. General information

NPI: 1891382974
Provider Name (Legal Business Name): IVEN DUPERA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 NW 41ST ST
MIAMI FL
33166-6817
US

IV. Provider business mailing address

1175 NW 155TH LN APT 207
MIAMI FL
33169-6327
US

V. Phone/Fax

Practice location:
  • Phone: 786-263-4040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number9420416
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11012611
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: