=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427586551
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POVIONES GARBALOSA ARNP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2017
-----------------------------------------------------
Last Update Date | 03/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11760 BIRD RD STE 539
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-8100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-228-6200
-----------------------------------------------------
Fax | 305-228-1314
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20230 NW 42ND AVE
-----------------------------------------------------
City | MIAMI GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33055-1335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-394-0811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROSA MARIA POVIONES GARBALOSA
-----------------------------------------------------
Credential | ARNP
-----------------------------------------------------
Telephone | 786-394-0811
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | ARNP9309698
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------