Provider Demographics
NPI:1376438861
Name:PALACIOS MARTINEZ, INARA MILAGRO ALEXANDRA (APRN)
Entity type:Individual
Prefix:
First Name:INARA
Middle Name:MILAGRO ALEXANDRA
Last Name:PALACIOS MARTINEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 BUENAVENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-8128
Mailing Address - Country:US
Mailing Address - Phone:407-348-0990
Mailing Address - Fax:321-203-4668
Practice Address - Street 1:790 BUENAVENTURA BLVD STE 206
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-8128
Practice Address - Country:US
Practice Address - Phone:407-348-0990
Practice Address - Fax:321-203-4668
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-12
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11040150363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL127521800Medicaid