Provider Demographics
NPI:1215393848
Name:VENCE NUNEZ, ANDRES
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:
Last Name:VENCE NUNEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 SW 125TH AVE
Mailing Address - Street 2:APT D 208
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7103
Mailing Address - Country:US
Mailing Address - Phone:305-989-6555
Mailing Address - Fax:
Practice Address - Street 1:9040 SW 125TH AVE
Practice Address - Street 2:APT D 208
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7103
Practice Address - Country:US
Practice Address - Phone:305-989-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14-423363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical