MEDICARE: MS. TATIANA RIQUELME FNP-C

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	363LF0000X	Family Nurse Practitioner	APRN11035232	FL
2	163W00000X	Registered Nurse	RN9446018	FL

General Provider Information

NPI Number	:	1609661685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TATIANA RIQUELME FNP-C

Provider Business Mailing Address
First Line	:	145 SW 13TH ST APT 332
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33130-4301
Country	:	US
Telephone Number	:	786-202-1609
Fax Number	:

Provider Business Practice Location Address
First Line	:	4304 ALTON RD
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-2885
Country	:	US
Telephone Number	:	305-674-2646
Fax Number	:	305-695-1370

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

Provider Enumeration Date	:	04/10/2025
Last Update Date	:	09/04/2025

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