Healthcare Provider Details

I. General information

NPI: 1013870658
Provider Name (Legal Business Name): JEIDY GONZALEZ ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5435 SW 155 ST CT
MIAMI FL
33185
US

IV. Provider business mailing address

5435 SW 155TH CT
MIAMI FL
33185-4186
US

V. Phone/Fax

Practice location:
  • Phone: 305-930-3665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11042127
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: