Healthcare Provider Details

I. General information

NPI: 1962876268
Provider Name (Legal Business Name): LEONEL BRAVO VIART ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LEONEL BRAVO

II. Dates (important events)

Enumeration Date: 11/24/2015
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 NW 36TH STREET
MIAMI FL
33166
US

IV. Provider business mailing address

4483 N.W. 36H STREET SUITE 120
MIAMI SPRINGS FL
33166
US

V. Phone/Fax

Practice location:
  • Phone: 305-871-3627
  • Fax: 305-871-7569
Mailing address:
  • Phone: 305-888-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9382241
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: