Provider Demographics
NPI:1124853437
Name:CORDERO, LLILIAM (ARNP-BC)
Entity type:Individual
Prefix:
First Name:LLILIAM
Middle Name:
Last Name:CORDERO
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10661 N KENDALL DR STE 104
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1593
Mailing Address - Country:US
Mailing Address - Phone:786-916-1352
Mailing Address - Fax:
Practice Address - Street 1:10661 N KENDALL DR STE 104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1593
Practice Address - Country:US
Practice Address - Phone:786-916-1352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2024042841363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner