Provider Demographics
NPI:1275177552
Name:MONTALVO DUPORTE, JUANA LIUDMILA
Entity Type:Individual
Prefix:
First Name:JUANA
Middle Name:LIUDMILA
Last Name:MONTALVO DUPORTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33972-3026
Mailing Address - Country:US
Mailing Address - Phone:305-496-8234
Mailing Address - Fax:
Practice Address - Street 1:8041 PLAZA DEL LAGO DR
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-5300
Practice Address - Country:US
Practice Address - Phone:239-494-3460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9379496163W00000X
FLAPRN11005205363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse