Provider Demographics
NPI:1194184192
Name:GOENAGA IGLESIAS, EDUARDO ANTONIO (FNP,ARNP,CSA)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:ANTONIO
Last Name:GOENAGA IGLESIAS
Suffix:
Gender:M
Credentials:FNP,ARNP,CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18940 NW 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5261
Mailing Address - Country:US
Mailing Address - Phone:786-873-1127
Mailing Address - Fax:
Practice Address - Street 1:18940 NW 78TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5261
Practice Address - Country:US
Practice Address - Phone:786-873-1127
Practice Address - Fax:888-468-6511
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023831363LF0000X
246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant