Provider Demographics
NPI:1508196684
Name:ESTRADA, AILEC ELENA (ARNP)
Entity Type:Individual
Prefix:
First Name:AILEC
Middle Name:ELENA
Last Name:ESTRADA
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:PO BOX 198054
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8054
Mailing Address - Country:US
Mailing Address - Phone:786-595-9930
Mailing Address - Fax:786-576-0455
Practice Address - Street 1:13101 S DIXIE HWY STE 400
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-6530
Practice Address - Country:US
Practice Address - Phone:786-595-9930
Practice Address - Fax:786-576-0455
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9250189363L00000X
FLRN 9250189363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily