Provider Demographics
NPI:1669920237
Name:MESTRE, MIGUEL JR
Entity type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:
Last Name:MESTRE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MIGUEL
Other - Middle Name:
Other - Last Name:MESTRE
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:ARNP-C
Mailing Address - Street 1:425 W COLONIAL DR STE 303
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6863
Mailing Address - Country:US
Mailing Address - Phone:321-332-6947
Mailing Address - Fax:
Practice Address - Street 1:33044 US HWY 27 N
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-7621
Practice Address - Country:US
Practice Address - Phone:863-422-4977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9198073163WG0000X
FLARNP9198073363L00000X, 363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology