Provider Demographics
NPI:1356651392
Name:VIANA, JACQUELINE (ARNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:VIANA
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 1:1111 BRICKELL BAY DR APT 2806
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2963
Mailing Address - Country:US
Mailing Address - Phone:305-301-2668
Mailing Address - Fax:
Practice Address - Street 1:7400 SW 87TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5458
Practice Address - Country:US
Practice Address - Phone:305-275-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9171476363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care