Provider Demographics
NPI:1700375052
Name:TRAVIESO JORGE, DORISLEY (ARNP)
Entity Type:Individual
Prefix:
First Name:DORISLEY
Middle Name:
Last Name:TRAVIESO JORGE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6423 SW 162ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5833
Mailing Address - Country:US
Mailing Address - Phone:305-766-4845
Mailing Address - Fax:
Practice Address - Street 1:19001 SW 106TH AVE
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7669
Practice Address - Country:US
Practice Address - Phone:305-255-9806
Practice Address - Fax:305-255-9807
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9402632163WG0000X, 363LF0000X
FLARNP9402632363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care