MEDICARE: VARGAS CLINIC LLC

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	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1578218871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VARGAS CLINIC LLC

Provider Business Mailing Address
First Line	:	14701 SW 107TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-7792
Country	:	US
Telephone Number	:	786-309-1772
Fax Number	:

Provider Business Practice Location Address
First Line	:	1452 NW 17TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-2323
Country	:	US
Telephone Number	:	786-309-1772
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HEIDY VARGAS
Credential	:	ARNP
Telephone Number	:	786-317-3227

Provider Enumeration Date	:	02/15/2022
Last Update Date	:	02/15/2022

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Directions to “VARGAS CLINIC LLC ” Practice Location

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