Provider Demographics
NPI:1770903791
Name:GARCIA TAMAYO, ALEXEIS (APRN)
Entity type:Individual
Prefix:
First Name:ALEXEIS
Middle Name:
Last Name:GARCIA TAMAYO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25217 SW 114TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6330
Mailing Address - Country:US
Mailing Address - Phone:786-307-5085
Mailing Address - Fax:
Practice Address - Street 1:25217 SW 114TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-6330
Practice Address - Country:US
Practice Address - Phone:786-307-5085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2021-10-20
Deactivation Date:2021-09-24
Deactivation Code:
Reactivation Date:2021-10-20
Provider Licenses
StateLicense IDTaxonomies
171M00000X
FL11015572363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No171M00000XOther Service ProvidersCase Manager/Care Coordinator