Provider Demographics
NPI:1134880479
Name:TIRADO SARMIENTO, MODESTO ALEJANDRO (APRN)
Entity type:Individual
Prefix:
First Name:MODESTO
Middle Name:ALEJANDRO
Last Name:TIRADO SARMIENTO
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 1:12470 SW 17TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-1563
Mailing Address - Country:US
Mailing Address - Phone:786-445-8558
Mailing Address - Fax:
Practice Address - Street 1:2141 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3483
Practice Address - Country:US
Practice Address - Phone:786-445-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-09
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11017386363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily