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
State | License ID | Taxonomies |
---|---|---|
FL | ALPP-315890 | 101Y00000X |
FL | 9497191 | 163W00000X |
FL | APRN11039862 | 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | ||
No | 163W00000X | Nursing Service Providers | Registered Nurse | Group - Single Specialty |