Provider Demographics
NPI:1063045813
Name:VALDES ABREU, IVAN RAFAEL (APRN-FNP-C)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:RAFAEL
Last Name:VALDES ABREU
Suffix:
Gender:M
Credentials:APRN-FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8891 MILLER DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-6771
Mailing Address - Country:US
Mailing Address - Phone:305-753-0053
Mailing Address - Fax:786-991-2304
Practice Address - Street 1:10300 SW 72ND ST STE 232
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3003
Practice Address - Country:US
Practice Address - Phone:786-991-2300
Practice Address - Fax:786-991-2304
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006247363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty