Provider Demographics
NPI:1104449644
Name:VANDAMA BRIZUELA, LUIS MANUEL (APRN)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:MANUEL
Last Name:VANDAMA BRIZUELA
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S HIATUS RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3617
Mailing Address - Country:US
Mailing Address - Phone:954-438-4000
Mailing Address - Fax:786-791-1270
Practice Address - Street 1:1500 S HIATUS RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-3617
Practice Address - Country:US
Practice Address - Phone:954-438-4000
Practice Address - Fax:786-791-1270
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007011363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily