Healthcare Provider Details

I. General information

NPI: 1144901174
Provider Name (Legal Business Name): AIMEE DOLORFINO MIYABAYASHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3090 CARUSO CT STE 20
ORLANDO FL
32806-8510
US

IV. Provider business mailing address

4510 KENNEWICK PL
RIVERVIEW FL
33578-2122
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-5236
  • Fax:
Mailing address:
  • Phone: 239-789-5295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN9504400
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11028606
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: