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General NPI Number Information
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NPI Number | 1720661036
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Entity Type | Individual
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Provider Name | ISIS M FONSECA
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Gender | Female
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Dates
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Enumeration Date | 05/04/2021
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Last Update Date | 05/04/2021
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Provider Practice Location Address
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Address Line | 3898 NW 7TH ST
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City | MIAMI
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State | FL
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Zip | 33126-5503
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Country | US
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Telephone | 305-644-9903
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Fax |
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Provider Business Mailing Address
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Address Line | 1822 SW 82 CT
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City | MIAMI
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State | FL
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Zip | 33155
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Country | US
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Telephone | 786-280-2004
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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 | 11002467
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License Number State | FL
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