Healthcare Provider Details

I. General information

NPI: 1073060786
Provider Name (Legal Business Name): FREDDY DUQUE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FREDDY DUQUE NP

II. Dates (important events)

Enumeration Date: 09/10/2016
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 NW 107TH AVE STE A
SWEETWATER FL
33172-2734
US

IV. Provider business mailing address

10345 NW 68TH TER
DORAL FL
33178-4616
US

V. Phone/Fax

Practice location:
  • Phone: 786-547-2091
  • Fax:
Mailing address:
  • Phone: 786-547-2091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberFNP-11036513
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP-3765
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: