Healthcare Provider Details

I. General information

NPI: 1265993356
Provider Name (Legal Business Name): BEATRIZ ILLA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9240 SW 72ND ST STE 241
MIAMI FL
33173-3265
US

IV. Provider business mailing address

10791 N KENDALL DR APT B208
MIAMI FL
33176-1462
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-1919
  • Fax: 305-271-1911
Mailing address:
  • Phone: 305-283-2399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11001346
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: