Provider Demographics
NPI:1124725619
Name:PUERTO ARIAS, OSMER LUIS (APRN)
Entity type:Individual
Prefix:
First Name:OSMER
Middle Name:LUIS
Last Name:PUERTO ARIAS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10045 CORTEZ BLVD STE 154
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6332
Mailing Address - Country:US
Mailing Address - Phone:352-596-6114
Mailing Address - Fax:352-596-0784
Practice Address - Street 1:10045 CORTEZ BLVD STE 154
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34613-6332
Practice Address - Country:US
Practice Address - Phone:352-596-6114
Practice Address - Fax:352-596-0784
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023896363LF0000X
FLAPRN11023896363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily