Provider Demographics
NPI:1821339870
Name:ALFONSO, NAIVY FATIMA (ARNP)
Entity Type:Individual
Prefix:
First Name:NAIVY
Middle Name:FATIMA
Last Name:ALFONSO
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 1:11211 SW 152ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1101
Mailing Address - Country:US
Mailing Address - Phone:305-255-1355
Mailing Address - Fax:
Practice Address - Street 1:665 NW 123RD PATH
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33182-2050
Practice Address - Country:US
Practice Address - Phone:786-247-2838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9294634363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner