Provider Demographics
NPI:1649766718
Name:HIDALGO, MICHAEL MARTIN (ARNP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:MARTIN
Last Name:HIDALGO
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11215 SW 236TH LN
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6252
Mailing Address - Country:US
Mailing Address - Phone:305-431-6353
Mailing Address - Fax:
Practice Address - Street 1:15820 SW 137TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1203
Practice Address - Country:US
Practice Address - Phone:786-801-3720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9352985363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care