Provider Demographics
NPI:1811473226
Name:BARATA HIDALGO, LUIS JOAQUIN (ARNP)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:JOAQUIN
Last Name:BARATA HIDALGO
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 DEL PRADO BLVD N STE 103
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-2210
Mailing Address - Country:US
Mailing Address - Phone:239-351-2044
Mailing Address - Fax:833-975-0941
Practice Address - Street 1:428 DEL PRADO BLVD N STE 103
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2210
Practice Address - Country:US
Practice Address - Phone:239-351-2044
Practice Address - Fax:833-975-0941
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9292540363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics