Healthcare Provider Details

I. General information

NPI: 1659850501
Provider Name (Legal Business Name): JACQUELINE TATIANA CUELLAR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2018
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 W FLAGLER ST STE 2I
MIAMI FL
33144-2069
US

IV. Provider business mailing address

9421 S ORANGE BLOSSOM TRL # 19
ORLANDO FL
32837-8320
US

V. Phone/Fax

Practice location:
  • Phone: 786-715-9183
  • Fax: 786-713-1115
Mailing address:
  • Phone: 407-601-2527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9406046
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9406046
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: