Provider Demographics
NPI:1194300111
Name:BRIZUELA ARIAS, LEANDRO ANTONIO (APRN)
Entity type:Individual
Prefix:
First Name:LEANDRO
Middle Name:ANTONIO
Last Name:BRIZUELA 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 1:1188 NW 123RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2403
Mailing Address - Country:US
Mailing Address - Phone:786-838-6190
Mailing Address - Fax:
Practice Address - Street 1:8501 SW 124TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4631
Practice Address - Country:US
Practice Address - Phone:786-808-8555
Practice Address - Fax:786-360-1100
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily