Healthcare Provider Details

I. General information

NPI: 1225945876
Provider Name (Legal Business Name): VIDA ROXANNE VELASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4429 SW 163RD PL
MIAMI FL
33185-4578
US

IV. Provider business mailing address

4429 SW 163RD PL
MIAMI FL
33185-4578
US

V. Phone/Fax

Practice location:
  • Phone: 305-609-9842
  • Fax:
Mailing address:
  • Phone: 305-609-9842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11050439
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: