Provider Demographics
NPI:1619429545
Name:DE LA NUEZ, ETIENNE
Entity Type:Individual
Prefix:
First Name:ETIENNE
Middle Name:
Last Name:DE LA NUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 SUNSET DR STE 302
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4829
Mailing Address - Country:US
Mailing Address - Phone:786-662-8122
Mailing Address - Fax:305-595-3088
Practice Address - Street 1:14660 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-3135
Practice Address - Country:US
Practice Address - Phone:786-888-8820
Practice Address - Fax:305-595-3088
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9261663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily