Provider Demographics
NPI:1598443756
Name:NIETO OSORIA, FERMIN (FNP)
Entity Type:Individual
Prefix:
First Name:FERMIN
Middle Name:
Last Name:NIETO OSORIA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N UNIVERSITY DR STE 110
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3618
Mailing Address - Country:US
Mailing Address - Phone:786-445-6847
Mailing Address - Fax:
Practice Address - Street 1:1900 N UNIVERSITY DR STE 110
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3618
Practice Address - Country:US
Practice Address - Phone:786-445-6847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily