Healthcare Provider Details

I. General information

NPI: 1689729733
Provider Name (Legal Business Name): GERALDA PHANOR FLEURANVIL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16751 NE 6TH AVE
NORTH MIAMI BEACH FL
33162
US

IV. Provider business mailing address

16751 NE 6TH AVE
NORTH MIAMI BEACH FL
33162-2409
US

V. Phone/Fax

Practice location:
  • Phone: 305-750-1158
  • Fax: 305-705-4292
Mailing address:
  • Phone: 786-564-9438
  • Fax: 305-705-4292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9104039
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: