Healthcare Provider Details

I. General information

NPI: 1063248771
Provider Name (Legal Business Name): ANTONELLA BAEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE STE 121
MIAMI FL
33155-3009
US

IV. Provider business mailing address

5955 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2423
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-8360
  • Fax: 833-464-4214
Mailing address:
  • Phone: 305-661-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11035192
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: