Provider Demographics
NPI:1912531989
Name:IZQUIERDO, KATHLEEN FRANCES (APRN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:FRANCES
Last Name:IZQUIERDO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7376 W 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1784
Mailing Address - Country:US
Mailing Address - Phone:786-868-5003
Mailing Address - Fax:
Practice Address - Street 1:7376 W 34TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-1784
Practice Address - Country:US
Practice Address - Phone:786-868-5003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005245363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty