Provider Demographics
NPI:1245809326
Name:MAHIQUE ARNP LLC
Entity type:Organization
Organization Name:MAHIQUE ARNP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:YANIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:786-405-3508
Mailing Address - Street 1:15880 SW 76TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2955
Mailing Address - Country:US
Mailing Address - Phone:786-405-3508
Mailing Address - Fax:
Practice Address - Street 1:15880 SW 76TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-2955
Practice Address - Country:US
Practice Address - Phone:786-405-3508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11010558OtherLICENSE