Healthcare Provider Details

I. General information

NPI: 1679121164
Provider Name (Legal Business Name): IGNACIO BERNAL JR. FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 N KENDALL DR
MIAMI FL
33186-1708
US

IV. Provider business mailing address

2575 SW 67TH AVE
MIAMI FL
33155-2968
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-3800
  • Fax:
Mailing address:
  • Phone: 305-266-2424
  • Fax: 305-692-0728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11004572
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: