Healthcare Provider Details

I. General information

NPI: 1669130860
Provider Name (Legal Business Name): JORGE ALEXANDER LEDEZMA SALAZAR ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2021
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 SW 160TH AVE
MIRAMAR FL
33027-4668
US

IV. Provider business mailing address

3901 SW 160TH AVE APT 105
MIRAMAR FL
33027-4668
US

V. Phone/Fax

Practice location:
  • Phone: 786-230-4381
  • Fax:
Mailing address:
  • Phone: 786-230-4381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11050141
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: