Healthcare Provider Details

I. General information

NPI: 1679134290
Provider Name (Legal Business Name): BIANCA MAURA CUERVO-RODRIGUEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 NW 14TH ST
MIAMI FL
33125-1673
US

IV. Provider business mailing address

1321 NW 14TH ST
MIAMI FL
33125-1673
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6946
  • Fax: 305-243-3337
Mailing address:
  • Phone: 305-243-6946
  • Fax: 305-243-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9340493
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: