=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275008187
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DISAEL LINARES ARNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2018
-----------------------------------------------------
Last Update Date | 10/06/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 720 SW 58TH CT
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-3928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-266-0011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14213 SW 110TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-3049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-338-2509
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 9323573
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------