Provider Demographics
NPI:1306489661
Name:LEYVA INFANTE, REYNALDO (APRN)
Entity type:Individual
Prefix:
First Name:REYNALDO
Middle Name:
Last Name:LEYVA INFANTE
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 1:437 LAKEVIEW DR APT 102
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2449
Mailing Address - Country:US
Mailing Address - Phone:786-484-4900
Mailing Address - Fax:
Practice Address - Street 1:437 LAKEVIEW DR APT 102
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-2449
Practice Address - Country:US
Practice Address - Phone:786-484-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9402781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily