MEDICARE: ADDIE MAUREEN DEPPA APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	11042517	FL

General Provider Information

NPI Number	:	1477410959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADDIE MAUREEN DEPPA APRN

Provider Business Mailing Address
First Line	:	1010 S DOUGLAS RD APT 3
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-3419
Country	:	US
Telephone Number	:	612-703-6533
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 NW 12TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33136-1003
Country	:	US
Telephone Number	:	305-325-5111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	01/07/2026

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Directions to “ ADDIE MAUREEN DEPPA APRN” Practice Location

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