Healthcare Provider Details

I. General information

NPI: 1316233414
Provider Name (Legal Business Name): MILAGROS D TABLANTE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE CARDIAC INTENSIVE CARE
MIAMI FL
33155-3009
US

IV. Provider business mailing address

12220 SW 108TH AVE
MIAMI FL
33176-4649
US

V. Phone/Fax

Practice location:
  • Phone: 305-669-6500
  • Fax: 305-668-6813
Mailing address:
  • Phone: 305-301-4253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1179132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: