Healthcare Provider Details

I. General information

NPI: 1780219758
Provider Name (Legal Business Name): ELISA ECHEVARRIA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

IV. Provider business mailing address

21110 BISCAYNE BLVD STE 308
AVENTURA FL
33180-1229
US

V. Phone/Fax

Practice location:
  • Phone: 786-624-4571
  • Fax:
Mailing address:
  • Phone: 305-932-1007
  • Fax: 305-696-6225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAPRN11004203
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11004203
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: