Provider Demographics
NPI:1689204729
Name:EIRANOVA, NATHALI (PA-C)
Entity Type:Individual
Prefix:
First Name:NATHALI
Middle Name:
Last Name:EIRANOVA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12600 SW 120TH ST STE 113
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-9116
Mailing Address - Country:US
Mailing Address - Phone:305-971-1210
Mailing Address - Fax:305-971-7710
Practice Address - Street 1:12600 SW 120TH ST STE 113
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-9116
Practice Address - Country:US
Practice Address - Phone:305-971-1210
Practice Address - Fax:305-971-7710
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant