Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | APRN11000049 | FL |
NPI | 1003384298 |
---|---|
Provider Name | Ms. Irina De Leon |
First Address | Miami, FL 33177-6170 |
Second Address | Miami, FL 33177-6170 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2018 |
Last Update Date | 06/11/2018 |