Provider Demographics
NPI:1275870792
Name:PENENORI MONTOTO, ANA MARIA (ARNP)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:MARIA
Last Name:PENENORI MONTOTO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 W 65TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6109
Mailing Address - Country:US
Mailing Address - Phone:786-205-4610
Mailing Address - Fax:305-825-2320
Practice Address - Street 1:1625 W 65TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6109
Practice Address - Country:US
Practice Address - Phone:786-205-4610
Practice Address - Fax:305-825-2320
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9245740363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health