Healthcare Provider Details

I. General information

NPI: 1477606846
Provider Name (Legal Business Name): LEONARD MIHAI VUICSIN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1611 NW 12TH AVE
MIAMI FL
33136-1096
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-8867
  • Fax: 305-585-8631
Mailing address:
  • Phone: 305-585-8867
  • Fax: 305-585-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11005766
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11005766
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA36367
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: