Provider Demographics
NPI:1114569910
Name:FUNDORA, AYLIN (MSN,APRN-BC)
Entity Type:Individual
Prefix:
First Name:AYLIN
Middle Name:
Last Name:FUNDORA
Suffix:
Gender:F
Credentials:MSN,APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 W 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4789
Mailing Address - Country:US
Mailing Address - Phone:786-521-4102
Mailing Address - Fax:
Practice Address - Street 1:5720 W 26TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-4789
Practice Address - Country:US
Practice Address - Phone:786-521-4102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-13
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily