Provider Demographics
NPI:1811444870
Name:VARGAS-ALVARADO, MADELINE
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:VARGAS-ALVARADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:305-500-2027
Mailing Address - Fax:305-500-2155
Practice Address - Street 1:4340 W HILLSBOROUGH AVE STE 20
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5560
Practice Address - Country:US
Practice Address - Phone:813-425-8970
Practice Address - Fax:877-531-4828
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9286680363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health