Provider Demographics
NPI:1184018970
Name:TATIS DE LA NUEZ, VICTOR (ARNP)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:TATIS DE LA NUEZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:601 N FLAMINGO ROAD
Practice Address - Street 2:SUITE 206
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1942
Practice Address - Country:US
Practice Address - Phone:954-844-6825
Practice Address - Fax:954-499-1227
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11023735363LF0000X
FLF08220754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL120231000Medicaid