Provider Demographics
NPI:1457623555
Name:BURGOS-JUTERAM, SIMONE MARIA (ARNP)
Entity Type:Individual
Prefix:MS
First Name:SIMONE
Middle Name:MARIA
Last Name:BURGOS-JUTERAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 NW 155TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1581
Mailing Address - Country:US
Mailing Address - Phone:954-292-3525
Mailing Address - Fax:
Practice Address - Street 1:10794 PINES BLVD
Practice Address - Street 2:BOULEVARD PROFFESSIONAL CENTRE
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3920
Practice Address - Country:US
Practice Address - Phone:954-704-4988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2614312363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health