Provider Demographics
NPI:1194368886
Name:JUSTI, IDALMYS (FNP)
Entity Type:Individual
Prefix:
First Name:IDALMYS
Middle Name:
Last Name:JUSTI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22467 SW 111TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-3015
Mailing Address - Country:US
Mailing Address - Phone:786-237-9016
Mailing Address - Fax:
Practice Address - Street 1:1127 NW 22ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2738
Practice Address - Country:US
Practice Address - Phone:786-464-5120
Practice Address - Fax:786-464-5125
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004779363LP0808X
FL11004779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMJ5859799OtherDEA