Provider Demographics
NPI:1821989740
Name:SOTOLONGO, MAIDENLY LAZARA (APRN)
Entity type:Individual
Prefix:
First Name:MAIDENLY
Middle Name:LAZARA
Last Name:SOTOLONGO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13120 SW 127TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7582
Mailing Address - Country:US
Mailing Address - Phone:786-719-2645
Mailing Address - Fax:
Practice Address - Street 1:2300 W 84TH ST STE 100
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5771
Practice Address - Country:US
Practice Address - Phone:305-563-9788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11040679363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner