Healthcare Provider Details

I. General information

NPI: 1033898176
Provider Name (Legal Business Name): IVETTE CHRISTINA MADRIGAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10860 SW 88TH ST STE 200
MIAMI FL
33176-2680
US

IV. Provider business mailing address

8200 SW 29TH ST
MIAMI FL
33155-2425
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-1300
  • Fax:
Mailing address:
  • Phone: 786-554-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11027500
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: