Provider Demographics
NPI:1447616644
Name:MENENDEZ, IBIS MERCEDES
Entity Type:Individual
Prefix:MS
First Name:IBIS
Middle Name:MERCEDES
Last Name:MENENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8476 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-2966
Mailing Address - Country:US
Mailing Address - Phone:305-951-4558
Mailing Address - Fax:
Practice Address - Street 1:7315 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-6704
Practice Address - Country:US
Practice Address - Phone:786-345-7734
Practice Address - Fax:786-231-6977
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FL9388484363LF0000X
FLAPRN9388484363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily