Healthcare Provider Details

I. General information

NPI: 1821989740
Provider Name (Legal Business Name): MAIDENLY LAZARA SOTOLONGO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13120 SW 127TH CT
MIAMI FL
33186-7582
US

IV. Provider business mailing address

13120 SW 127TH CT
MIAMI FL
33186-7582
US

V. Phone/Fax

Practice location:
  • Phone: 786-719-2645
  • Fax:
Mailing address:
  • Phone: 786-719-2645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11040679
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: