Provider Demographics
NPI:1336721307
Name:AGUERREBERE ELIZALDE, RAMIRO (APRN, MSN, FNP, BC)
Entity Type:Individual
Prefix:
First Name:RAMIRO
Middle Name:
Last Name:AGUERREBERE ELIZALDE
Suffix:
Gender:M
Credentials:APRN, MSN, FNP, BC
Other - Prefix:
Other - First Name:RAMIRO
Other - Middle Name:
Other - Last Name:AGUERREBERE ELIZALDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15611 SW 63RD TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2803
Mailing Address - Country:US
Mailing Address - Phone:786-291-6351
Mailing Address - Fax:
Practice Address - Street 1:15611 SW 63RD TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-2803
Practice Address - Country:US
Practice Address - Phone:786-291-6351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011537363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily