Provider Demographics
NPI:1235809369
Name:NEIRA ARIAS, ITALO ANDRES (APRN)
Entity Type:Individual
Prefix:
First Name:ITALO
Middle Name:ANDRES
Last Name:NEIRA ARIAS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 DWYER LN
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1809
Mailing Address - Country:US
Mailing Address - Phone:407-449-3686
Mailing Address - Fax:
Practice Address - Street 1:1442 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1647
Practice Address - Country:US
Practice Address - Phone:407-878-1734
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11015466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily