Provider Demographics
NPI:1508343492
Name:TRAVIESO, MAGALY (APRN)
Entity Type:Individual
Prefix:
First Name:MAGALY
Middle Name:
Last Name:TRAVIESO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9380 SW 72ND ST STE B240
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-5483
Mailing Address - Country:US
Mailing Address - Phone:305-639-8095
Mailing Address - Fax:305-392-0775
Practice Address - Street 1:9380 SW 72ND ST
Practice Address - Street 2:STE B240
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5483
Practice Address - Country:US
Practice Address - Phone:786-580-1859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9240892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFEINOther833998742