Provider Demographics
NPI:1912605791
Name:IZQUIERDO HERNANDEZ, JUANA ROSA (FNP)
Entity Type:Individual
Prefix:
First Name:JUANA
Middle Name:ROSA
Last Name:IZQUIERDO HERNANDEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 SW 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-3941
Mailing Address - Country:US
Mailing Address - Phone:786-718-3312
Mailing Address - Fax:
Practice Address - Street 1:815 NW 57TH AVE STE 207
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2041
Practice Address - Country:US
Practice Address - Phone:786-718-3312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11024657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily