Provider Demographics
NPI:1093473662
Name:GIRALDO RESTREPO, MAURICIO (APRN)
Entity Type:Individual
Prefix:
First Name:MAURICIO
Middle Name:
Last Name:GIRALDO RESTREPO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16850 COLLINS AVE APT 515
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4238
Mailing Address - Country:US
Mailing Address - Phone:954-647-4360
Mailing Address - Fax:
Practice Address - Street 1:200 EAST HALLANDALE BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE
Practice Address - State:FL
Practice Address - Zip Code:33009
Practice Address - Country:US
Practice Address - Phone:954-362-8677
Practice Address - Fax:954-458-8167
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11016171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily