Provider Demographics
NPI:1194498089
Name:FONSECA, ANA IVONNE (NP)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:IVONNE
Last Name:FONSECA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14416 SW 46TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6834
Mailing Address - Country:US
Mailing Address - Phone:786-210-5169
Mailing Address - Fax:
Practice Address - Street 1:14416 SW 46TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6834
Practice Address - Country:US
Practice Address - Phone:786-210-5169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11013883363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily