Provider Demographics
NPI:1043074925
Name:NIETO, SOPHIA (APRN)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:NIETO
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 1:5308 ASHTON MANOR DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5213
Mailing Address - Country:US
Mailing Address - Phone:941-879-3473
Mailing Address - Fax:
Practice Address - Street 1:5308 ASHTON MANOR DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5213
Practice Address - Country:US
Practice Address - Phone:941-879-3473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11030711363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily