Provider Demographics
NPI:1861020943
Name:RAD, ALLISON JUSTINE (APRN)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:JUSTINE
Last Name:RAD
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 1:12260 SW 98TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-2530
Mailing Address - Country:US
Mailing Address - Phone:305-742-1196
Mailing Address - Fax:
Practice Address - Street 1:12260 SW 98TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-2530
Practice Address - Country:US
Practice Address - Phone:305-742-1196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005377363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily