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General NPI Number Information
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NPI Number | 1053698910
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Entity Type | Individual
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Provider Name | AMY J PANTALEO NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 11/07/2011
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Last Update Date | 02/04/2024
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Provider Practice Location Address
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Address Line | 21414 W DIXIE HWY
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City | AVENTURA
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State | FL
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Zip | 33180-1144
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Country | US
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Telephone | 786-626-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 1612 JEFFERSON AVE APT 401
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City | MIAMI BEACH
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State | FL
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Zip | 33139-7613
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Country | US
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Telephone | 786-626-7555
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71003856A
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License Number State | IN
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