Provider Demographics
NPI:1881390805
Name:CUBA TELLEZ, MIGUEL LEONARDO (FNP)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:LEONARDO
Last Name:CUBA TELLEZ
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16950 SW 93RD AVE
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4413
Mailing Address - Country:US
Mailing Address - Phone:786-704-2432
Mailing Address - Fax:
Practice Address - Street 1:16950 SW 93RD AVE
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-4413
Practice Address - Country:US
Practice Address - Phone:786-704-2432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11022553363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily