Provider Demographics
NPI:1417590860
Name:GARCIA ALONSO, IVAN (APRN)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:GARCIA ALONSO
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 1:1300 SW 122ND AVE
Mailing Address - Street 2:APT 111CA
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2815
Mailing Address - Country:US
Mailing Address - Phone:786-975-8763
Mailing Address - Fax:
Practice Address - Street 1:1300 SW 122ND AVE
Practice Address - Street 2:APT 111CA
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-2815
Practice Address - Country:US
Practice Address - Phone:786-975-8763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-17
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004667363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily