Provider Demographics
NPI:1376504928
Name:TEIXEIRO, PURA M (ARNP)
Entity Type:Individual
Prefix:
First Name:PURA
Middle Name:M
Last Name:TEIXEIRO
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 1:12951 SW 85TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4325
Mailing Address - Country:US
Mailing Address - Phone:305-283-2740
Mailing Address - Fax:305-547-1516
Practice Address - Street 1:1250 NW 7TH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3744
Practice Address - Country:US
Practice Address - Phone:305-547-1496
Practice Address - Fax:305-547-1516
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1946922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY051UMedicaid
FLY051UMedicaid