Provider Demographics
NPI:1033748041
Name:COELLO BLANCO, LIANET ESTHER (APRN)
Entity Type:Individual
Prefix:
First Name:LIANET
Middle Name:ESTHER
Last Name:COELLO BLANCO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 SW 24TH ST APT C36
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7978
Mailing Address - Country:US
Mailing Address - Phone:786-925-7779
Mailing Address - Fax:
Practice Address - Street 1:10300 SW 24TH ST APT C36
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7978
Practice Address - Country:US
Practice Address - Phone:786-925-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006473363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily