Healthcare Provider Details

I. General information

NPI: 1912789355
Provider Name (Legal Business Name): RADHAIMILDA CUEVAS MATOS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 11/08/2025
Certification Date: 11/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5973 CURRY FORD RD
ORLANDO FL
32822-2945
US

IV. Provider business mailing address

5973 CURRY FORD RD APT 344
ORLANDO FL
32822-4264
US

V. Phone/Fax

Practice location:
  • Phone: 787-972-9556
  • Fax: 787-972-9556
Mailing address:
  • Phone: 787-972-9556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11029192
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: