Provider Demographics
NPI:1114439841
Name:PUERTOLAS, NELVA ROSA (ARNP)
Entity Type:Individual
Prefix:
First Name:NELVA
Middle Name:ROSA
Last Name:PUERTOLAS
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 1:1000 NW 57TH CT STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3284
Mailing Address - Country:US
Mailing Address - Phone:305-649-8100
Mailing Address - Fax:305-649-8778
Practice Address - Street 1:5378 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2165
Practice Address - Country:US
Practice Address - Phone:305-820-4101
Practice Address - Fax:305-820-2885
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9294402363LW0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health