Provider Demographics
NPI:1700322971
Name:PENA, ILIANA MARIA (ARNP)
Entity Type:Individual
Prefix:
First Name:ILIANA
Middle Name:MARIA
Last Name:PENA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ILIANA
Other - Middle Name:MARIA
Other - Last Name:HERNANDEZ-DELGADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11940 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1608
Mailing Address - Country:US
Mailing Address - Phone:786-329-1824
Mailing Address - Fax:
Practice Address - Street 1:8950 N KENDALL DR
Practice Address - Street 2:SUITE 407 W
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2144
Practice Address - Country:US
Practice Address - Phone:305-271-6159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9326677363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily