Provider Demographics
NPI:1114435542
Name:FIGUEREDO BREA, MAIRELIS (ARNP)
Entity Type:Individual
Prefix:
First Name:MAIRELIS
Middle Name:
Last Name:FIGUEREDO BREA
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 1:5564 E GRANT ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-1666
Mailing Address - Country:US
Mailing Address - Phone:321-235-6230
Mailing Address - Fax:321-235-6246
Practice Address - Street 1:865 BUENAVENTURA BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-8125
Practice Address - Country:US
Practice Address - Phone:321-235-6230
Practice Address - Fax:321-235-6246
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9445371363LF0000X
FLARNP9445371363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF08171036OtherARNP BOARDS
FLMF5243275OtherDEA