Provider Demographics
NPI:1407693104
Name:PALACIOS CHANG, MAVYS (FNP)
Entity type:Individual
Prefix:
First Name:MAVYS
Middle Name:
Last Name:PALACIOS CHANG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MAVYS
Other - Middle Name:
Other - Last Name:PALACIOS FERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:12520 NW 23RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33167-1497
Mailing Address - Country:US
Mailing Address - Phone:786-890-9809
Mailing Address - Fax:
Practice Address - Street 1:12520 NW 23RD PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33167-1497
Practice Address - Country:US
Practice Address - Phone:786-890-9809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF06241467363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty