Healthcare Provider Details

I. General information

NPI: 1114266301
Provider Name (Legal Business Name): MARIA IVONNE ESPANA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62 AVENUE
MIAMI FL
33155
US

IV. Provider business mailing address

14762 SW 9TH LANE
MIAMI FL
33194
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-8357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9210097
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: