Provider Demographics
NPI:1760941108
Name:PACHECO, AYESHA ENID (ARNP-FNP)
Entity Type:Individual
Prefix:
First Name:AYESHA
Middle Name:ENID
Last Name:PACHECO
Suffix:
Gender:F
Credentials:ARNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8051 SW 158TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-3042
Mailing Address - Country:US
Mailing Address - Phone:786-370-4712
Mailing Address - Fax:
Practice Address - Street 1:8051 SW 158TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-3042
Practice Address - Country:US
Practice Address - Phone:786-370-4712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11001290363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily