Healthcare Provider Details

I. General information

NPI: 1831794619
Provider Name (Legal Business Name): SOPHIA MARIA ESPINOSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10575 68TH AVE
SEMINOLE FL
33772-6035
US

IV. Provider business mailing address

27224 SNAPPER CREEK LN
WESLEY CHAPEL FL
33544-5650
US

V. Phone/Fax

Practice location:
  • Phone: 305-970-3423
  • Fax:
Mailing address:
  • Phone: 305-970-3423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11010211
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9295471
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: