Provider Demographics
NPI:1447875182
Name:URIBE PRIETO, AMANDA DEYANIRA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:DEYANIRA
Last Name:URIBE PRIETO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 SAINT GABRIELLE LN APT 4206
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-4029
Mailing Address - Country:US
Mailing Address - Phone:954-512-3737
Mailing Address - Fax:
Practice Address - Street 1:3625 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33312-1082
Practice Address - Country:US
Practice Address - Phone:954-512-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLALPP-315890101Y00000X
FL9497191163W00000X
FLAPRN11039862363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty