Provider Demographics
NPI:1316582166
Name:ARENCIBIA ROBERTO, ALEXEIS
Entity type:Individual
Prefix:
First Name:ALEXEIS
Middle Name:
Last Name:ARENCIBIA ROBERTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9020 NW 8TH ST APT 310
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-3305
Mailing Address - Country:US
Mailing Address - Phone:954-536-6418
Mailing Address - Fax:
Practice Address - Street 1:400 E MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3866
Practice Address - Country:US
Practice Address - Phone:305-278-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily