Provider Demographics
NPI:1639882772
Name:ENRIQUEZ, LUCIA (CNM)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8104 SW 150TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1435
Mailing Address - Country:US
Mailing Address - Phone:786-712-5506
Mailing Address - Fax:
Practice Address - Street 1:5780 PEACHTREE DUNWOODY RD STE 195
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1513
Practice Address - Country:US
Practice Address - Phone:770-751-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN285134363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty