Provider Demographics
NPI:1184397606
Name:LARACUENTE HEALTHCARE ASSOCIATES
Entity type:Organization
Organization Name:LARACUENTE HEALTHCARE ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:ALFREDO
Authorized Official - Last Name:LARACUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, FNP-BC
Authorized Official - Phone:954-451-1743
Mailing Address - Street 1:1250 E HALLANDALE BEACH BLVD STE 1004
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4636
Mailing Address - Country:US
Mailing Address - Phone:954-451-1743
Mailing Address - Fax:954-838-5336
Practice Address - Street 1:1250 E HALLANDALE BEACH BLVD STE 1004
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4636
Practice Address - Country:US
Practice Address - Phone:954-451-1743
Practice Address - Fax:954-838-5336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & FamilyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112571000Medicaid
FL11094077Medicaid