Provider Demographics
NPI:1073616975
Name:NAGBUYA POTESTADES, PRISCILLA C (ARNP)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:C
Last Name:NAGBUYA POTESTADES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 FORUM WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401
Mailing Address - Country:US
Mailing Address - Phone:561-478-1104
Mailing Address - Fax:561-478-9505
Practice Address - Street 1:1401 FORUM WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401
Practice Address - Country:US
Practice Address - Phone:561-478-1104
Practice Address - Fax:561-478-9505
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2008182363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P85242Medicare UPIN
FLU0431Medicare ID - Type Unspecified