Provider Demographics
NPI:1104345362
Name:PORTIELES, ANAY (ARNP)
Entity type:Individual
Prefix:
First Name:ANAY
Middle Name:
Last Name:PORTIELES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7112 SW 103RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1377
Mailing Address - Country:US
Mailing Address - Phone:786-253-3360
Mailing Address - Fax:
Practice Address - Street 1:9299 SW 152ND ST STE 202
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1776
Practice Address - Country:US
Practice Address - Phone:305-255-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9327236363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner