Healthcare Provider Details

I. General information

NPI: 1568239598
Provider Name (Legal Business Name): ALTINAY CUERVO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11731 MILLS DR STE 109
MIAMI FL
33183-4844
US

IV. Provider business mailing address

15620 SW 58TH ST
MIAMI FL
33193-2524
US

V. Phone/Fax

Practice location:
  • Phone: 305-420-2800
  • Fax:
Mailing address:
  • Phone: 786-356-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11029880
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: