Provider Demographics
NPI:1164902722
Name:AMADOR, SERGIO X (NP-C)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:X
Last Name:AMADOR
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10730 SW 139TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-3173
Mailing Address - Country:US
Mailing Address - Phone:305-606-2003
Mailing Address - Fax:
Practice Address - Street 1:10730 SW 139TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-3173
Practice Address - Country:US
Practice Address - Phone:305-606-2003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF08180310363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner