Provider Demographics
NPI:1063761203
Name:LARACUENTE, MINEDY (APRN)
Entity type:Individual
Prefix:MS
First Name:MINEDY
Middle Name:
Last Name:LARACUENTE
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 1:1134 KELTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3100
Mailing Address - Country:US
Mailing Address - Phone:407-635-3333
Mailing Address - Fax:407-306-6375
Practice Address - Street 1:1134 KELTON AVE STE B
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3100
Practice Address - Country:US
Practice Address - Phone:407-635-3333
Practice Address - Fax:407-306-6375
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9254397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279688100Medicaid
FL99931Medicare UPIN