Provider Demographics
NPI:1124601232
Name:PADILLA, FIDEL (ARNP-FNP)
Entity Type:Individual
Prefix:MR
First Name:FIDEL
Middle Name:
Last Name:PADILLA
Suffix:
Gender:M
Credentials:ARNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8187 NW 8TH ST APT 215
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2895
Mailing Address - Country:US
Mailing Address - Phone:786-774-2705
Mailing Address - Fax:
Practice Address - Street 1:8187 NW 8TH ST APT 215
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2895
Practice Address - Country:US
Practice Address - Phone:786-774-2705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
FLRN9552371163W00000X
FLAPRN11025694363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No163W00000XNursing Service ProvidersRegistered Nurse