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General NPI Number Information
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NPI Number | 1992303101
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Entity Type | Individual
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Provider Name | ROBERTO REYES NIEVES APRN
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Gender | Male
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Dates
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Enumeration Date | 10/12/2020
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Last Update Date | 04/14/2023
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Provider Practice Location Address
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Address Line | 14221 SW 120TH ST STE 129
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City | MIAMI
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State | FL
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Zip | 33186-7463
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Country | US
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Telephone | 862-929-6507
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Fax | 786-420-3240
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Provider Business Mailing Address
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Address Line | 14221 SW 120TH ST STE 129
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City | MIAMI
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State | FL
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Zip | 33186-7463
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Country | US
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Telephone | 786-292-9650
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Fax | 786-420-3240
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 100985
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11024706
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License Number State | FL
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