Provider Demographics
NPI:1043029200
Name:BERMUDEZ, EILEEN
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 SW 60TH CT STE SUITE104
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4000
Mailing Address - Country:US
Mailing Address - Phone:305-669-6448
Mailing Address - Fax:833-950-1145
Practice Address - Street 1:3200 SW 60TH CT STE SUITE104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4000
Practice Address - Country:US
Practice Address - Phone:305-669-6448
Practice Address - Fax:833-950-1145
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11035738363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics