Provider Demographics
NPI:1396991915
Name:PEON VINENT, GRETEL (ARNP)
Entity type:Individual
Prefix:
First Name:GRETEL
Middle Name:
Last Name:PEON VINENT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14474 SW 174TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-6637
Mailing Address - Country:US
Mailing Address - Phone:786-356-8876
Mailing Address - Fax:
Practice Address - Street 1:14474 SW 174TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-6637
Practice Address - Country:US
Practice Address - Phone:786-356-8876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2022-06-13
Deactivation Date:2022-04-15
Deactivation Code:
Reactivation Date:2022-06-02
Provider Licenses
StateLicense IDTaxonomies
104100000X
FLF03220663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No104100000XBehavioral Health & Social Service ProvidersSocial Worker