Provider Demographics
NPI:1912547019
Name:ESTRADA MOLINA, EVELIO VARANY (APRN, CBHCM-S)
Entity Type:Individual
Prefix:MR
First Name:EVELIO
Middle Name:VARANY
Last Name:ESTRADA MOLINA
Suffix:
Gender:M
Credentials:APRN, CBHCM-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11117 W OKEECHOBEE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4200
Mailing Address - Country:US
Mailing Address - Phone:786-438-9145
Mailing Address - Fax:
Practice Address - Street 1:11117 W OKEECHOBEE RD STE 104
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4200
Practice Address - Country:US
Practice Address - Phone:786-438-9145
Practice Address - Fax:786-408-5853
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS100904171M00000X
FLAPRN11007522363LF0000X, 363LP2300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care