Provider Demographics
NPI:1285277996
Name:PALACIOS REYES, JUSTINA (APRNCB)
Entity type:Individual
Prefix:
First Name:JUSTINA
Middle Name:
Last Name:PALACIOS REYES
Suffix:
Gender:F
Credentials:APRNCB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6963 W 5TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4944
Mailing Address - Country:US
Mailing Address - Phone:786-250-7894
Mailing Address - Fax:
Practice Address - Street 1:6963 W 5TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4944
Practice Address - Country:US
Practice Address - Phone:786-250-7894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF10190681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily