Provider Demographics
NPI:1336620665
Name:ENRIQUE, ERNESTO (ARNP, AGNP-BC)
Entity type:Individual
Prefix:
First Name:ERNESTO
Middle Name:
Last Name:ENRIQUE
Suffix:
Gender:M
Credentials:ARNP, AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 SW 122ND AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2839
Mailing Address - Country:US
Mailing Address - Phone:305-250-8041
Mailing Address - Fax:
Practice Address - Street 1:15105 NW 77TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-7803
Practice Address - Country:US
Practice Address - Phone:305-455-2737
Practice Address - Fax:305-455-2738
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9411036363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty