Healthcare Provider Details

I. General information

NPI: 1215436993
Provider Name (Legal Business Name): DESIREE RENGIFO-GLASGOW ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11865 SW 26TH ST STE J2
MIAMI FL
33175
US

IV. Provider business mailing address

5120 NW 173RD DR
MIAMI GARDENS FL
33055-3631
US

V. Phone/Fax

Practice location:
  • Phone: 305-225-5950
  • Fax:
Mailing address:
  • Phone: 786-439-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9327949
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9327949
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: