Healthcare Provider Details

I. General information

NPI: 1104313402
Provider Name (Legal Business Name): JORGE L SOLER IGLESIAS NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JORGE LUIS SOLER IGLESIAS NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 NW 95TH ST
MIAMI FL
33147-2414
US

IV. Provider business mailing address

2230 NW 95TH ST
MIAMI FL
33147-2414
US

V. Phone/Fax

Practice location:
  • Phone: 305-827-2977
  • Fax: 305-820-6374
Mailing address:
  • Phone: 305-827-2977
  • Fax: 305-820-6374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11038363
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: