Provider Demographics
NPI:1407435993
Name:ALFONSO, ALBERTO NICOLAS (APRN)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:NICOLAS
Last Name:ALFONSO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 SW 139TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-3036
Mailing Address - Country:US
Mailing Address - Phone:786-366-6637
Mailing Address - Fax:
Practice Address - Street 1:921 SW 139TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-3036
Practice Address - Country:US
Practice Address - Phone:786-366-6637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-03
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11012362363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily