Provider Demographics
NPI:1639887268
Name:DUQUE, SEBASTIAN (APRN)
Entity Type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:
Last Name:DUQUE
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 1:9407 SW 222ND LN
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1468
Mailing Address - Country:US
Mailing Address - Phone:305-803-4065
Mailing Address - Fax:
Practice Address - Street 1:9407 SW 222ND LN
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1468
Practice Address - Country:US
Practice Address - Phone:305-803-4065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11022812363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner