Healthcare Provider Details

I. General information

NPI: 1689025033
Provider Name (Legal Business Name): GRACIELA ROQUE LINARES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10760 W FLAGLER ST STE 11
MIAMI FL
33174-4404
US

IV. Provider business mailing address

10760 W FLAGLER ST STE 11
MIAMI FL
33174-4404
US

V. Phone/Fax

Practice location:
  • Phone: 305-554-5144
  • Fax: 855-676-6399
Mailing address:
  • Phone: 305-554-5144
  • Fax: 855-676-6399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9306890
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: