Provider Demographics
NPI:1972682326
Name:KLOS, DAVID (APRN)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KLOS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NW 12TH AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1003
Mailing Address - Country:US
Mailing Address - Phone:305-243-3000
Mailing Address - Fax:305-324-5552
Practice Address - Street 1:1400 NW 12TH AVE STE 306
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1003
Practice Address - Country:US
Practice Address - Phone:305-243-3000
Practice Address - Fax:305-324-5552
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2827363LA2200X
FLARNP 9377218363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0962Medicaid
SCNP0962Medicaid
SCAA12667041Medicare PIN
SCQ65530Medicare UPIN