Provider Demographics
NPI:1639646086
Name:AYOUB, ADNAN A (APRN)
Entity Type:Individual
Prefix:MR
First Name:ADNAN
Middle Name:A
Last Name:AYOUB
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 1:1680 MICHIGAN AVE STE 912
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-2550
Mailing Address - Country:US
Mailing Address - Phone:305-576-1234
Mailing Address - Fax:
Practice Address - Street 1:1680 MICHIGAN AVE STE 912
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-2550
Practice Address - Country:US
Practice Address - Phone:305-576-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138258363LF0000X
MN6336363LF0000X
FLAPRN11002964363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty