Healthcare Provider Details

I. General information

NPI: 1396649588
Provider Name (Legal Business Name): JOAQUIN JESUS CABRERA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16309 SW 79TH TER FL USA
MIAMI FL
33193-3431
US

IV. Provider business mailing address

16309 SW 79TH TER FL USA
MIAMI FL
33193-3431
US

V. Phone/Fax

Practice location:
  • Phone: 786-553-5507
  • Fax:
Mailing address:
  • Phone: 786-553-5507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11051301
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: