Provider Demographics
NPI:1194459388
Name:URDANETA, MARIAM S (ARNP, FNP-C)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:S
Last Name:URDANETA
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 E PALMETTO PARK RD APT 455
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5186
Mailing Address - Country:US
Mailing Address - Phone:786-515-4559
Mailing Address - Fax:
Practice Address - Street 1:64 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-4805
Practice Address - Country:US
Practice Address - Phone:786-515-4559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9521113364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health