Provider Demographics
NPI:1841751781
Name:ANDRADE, DAIMI (APRN)
Entity Type:Individual
Prefix:
First Name:DAIMI
Middle Name:
Last Name:ANDRADE
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 1:8952 SW 142ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1297
Mailing Address - Country:US
Mailing Address - Phone:786-344-2605
Mailing Address - Fax:
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:305-669-6555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-09-03
Deactivation Date:2019-03-27
Deactivation Code:
Reactivation Date:2019-05-15
Provider Licenses
StateLicense IDTaxonomies
FL11002007363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1841751781Medicaid