Provider Demographics
NPI:1407292014
Name:MENDIETA, ERICK MANUEL (ARNP)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:MANUEL
Last Name:MENDIETA
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 S OCEAN DR
Mailing Address - Street 2:APT 501
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-2830
Mailing Address - Country:US
Mailing Address - Phone:786-229-8334
Mailing Address - Fax:
Practice Address - Street 1:3001 S OCEAN DR
Practice Address - Street 2:APT 501
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-2830
Practice Address - Country:US
Practice Address - Phone:786-229-8334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9243359282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital