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General NPI Number Information
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NPI Number | 1972233815
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Entity Type | Organization
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Legal Business Name | ADVANCE AUTONOMOUS MEDICAL GROUP
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Dates
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Enumeration Date | 06/14/2022
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Last Update Date | 03/13/2023
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Provider Practice Location Address
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Address Line | 2103 RENAISSANCE BLVD APT 107
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City | MIRAMAR
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State | FL
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Zip | 33025-5691
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Country | US
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Telephone | 786-631-8382
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Fax |
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Provider Business Mailing Address
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Address Line | 2103 RENAISSANCE BLVD APT 107
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City | MIRAMAR
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State | FL
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Zip | 33025-5691
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTONOMOUS NURSE PRACTITIONER
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Name | CARLOS ALBERTO LEON
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Credential | APRN
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Telephone | 786-631-8382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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