Provider Demographics
NPI:1205363868
Name:MIRANDA AGUERO, NAYVIS (APRN)
Entity type:Individual
Prefix:
First Name:NAYVIS
Middle Name:
Last Name:MIRANDA AGUERO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7867 W 36TH AVE UNIT 104
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-7530
Mailing Address - Country:US
Mailing Address - Phone:786-704-2068
Mailing Address - Fax:
Practice Address - Street 1:10550 NW 77TH CT STE 308
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-2072
Practice Address - Country:US
Practice Address - Phone:305-863-2233
Practice Address - Fax:305-504-8813
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11023968363LP2300X
FL11023968363L00000X
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty