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General NPI Number Information
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NPI Number | 1053017913
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Entity Type | Individual
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Provider Name | CASEY MINEROS
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Gender | Female
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Dates
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Enumeration Date | 02/02/2023
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 5955 PONCE DE LEON BLVD
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City | CORAL GABLES
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State | FL
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Zip | 33146-2423
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Country | US
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Telephone | 305-661-1515
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Fax |
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Provider Business Mailing Address
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Address Line | 5006 SW 91ST AVE
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City | COOPER CITY
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State | FL
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Zip | 33328-3522
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Country | US
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Telephone | 754-422-6015
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | PA9119419
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License Number State | FL
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