Provider Demographics
NPI:1508488503
Name:OLIVERA, GIRALDO (APRN)
Entity Type:Individual
Prefix:MR
First Name:GIRALDO
Middle Name:
Last Name:OLIVERA
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 1:481 NORTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-4166
Mailing Address - Country:US
Mailing Address - Phone:786-873-7045
Mailing Address - Fax:
Practice Address - Street 1:481 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-4166
Practice Address - Country:US
Practice Address - Phone:786-873-7045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily