Healthcare Provider Details

I. General information

NPI: 1497362842
Provider Name (Legal Business Name): AMARILIS AGUILERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 1ST ST S
WINTER HAVEN FL
33880-3255
US

IV. Provider business mailing address

205 1ST ST S STE 101
WINTER HAVEN FL
33880-3266
US

V. Phone/Fax

Practice location:
  • Phone: 863-877-0064
  • Fax:
Mailing address:
  • Phone: 863-877-0064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1741
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: