Healthcare Provider Details

I. General information

NPI: 1538750443
Provider Name (Legal Business Name): MRS. ALEXANDRA GLADYS VARONA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NW 17TH ST
MIAMI FL
33136-1119
US

IV. Provider business mailing address

221 SW 19TH AVE
MIAMI FL
33135-1714
US

V. Phone/Fax

Practice location:
  • Phone: 305-326-6543
  • Fax:
Mailing address:
  • Phone: 305-608-6283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11011058
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: