Provider Demographics
NPI:1417762972
Name:CUELLAR, LIETTY
Entity type:Individual
Prefix:
First Name:LIETTY
Middle Name:
Last Name:CUELLAR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6036 NW 194TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4812
Mailing Address - Country:US
Mailing Address - Phone:305-775-0728
Mailing Address - Fax:
Practice Address - Street 1:6036 NW 194TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4812
Practice Address - Country:US
Practice Address - Phone:305-775-0728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-03-17
Deactivation Date:2025-03-07
Deactivation Code:
Reactivation Date:2025-03-17
Provider Licenses
StateLicense IDTaxonomies
FLF02250408363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily