Healthcare Provider Details

I. General information

NPI: 1619210127
Provider Name (Legal Business Name): GRACIELA URIAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 HEALTH PARK CIR
MOORE HAVEN FL
33471-6206
US

IV. Provider business mailing address

1021 HEALTH PARK CIR
MOORE HAVEN FL
33471-6206
US

V. Phone/Fax

Practice location:
  • Phone: 863-946-0707
  • Fax: 863-946-3097
Mailing address:
  • Phone: 863-946-0707
  • Fax: 863-946-3097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9329393
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: