Provider Demographics
NPI:1619665395
Name:PINO OLIVEROS, LUANDA ALICIA (APRN FNP-C)
Entity Type:Individual
Prefix:
First Name:LUANDA
Middle Name:ALICIA
Last Name:PINO OLIVEROS
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 NE 30TH ST APT 413
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-4382
Mailing Address - Country:US
Mailing Address - Phone:786-585-6567
Mailing Address - Fax:
Practice Address - Street 1:1303 HOMESTEAD RD N STE 102
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6049
Practice Address - Country:US
Practice Address - Phone:239-303-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11025768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily