Provider Demographics
NPI:1770391666
Name:GARCIA BIANCHI, JACQUELINE SOFIA (FNP)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:SOFIA
Last Name:GARCIA BIANCHI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15382 SW 15TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2670
Mailing Address - Country:US
Mailing Address - Phone:305-710-0527
Mailing Address - Fax:
Practice Address - Street 1:15382 SW 15TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33194-2670
Practice Address - Country:US
Practice Address - Phone:305-710-0527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11036880363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily