Provider Demographics
NPI:1427758689
Name:ALVAREZ ELIZUNDIA, ARDO (APRN)
Entity type:Individual
Prefix:
First Name:ARDO
Middle Name:
Last Name:ALVAREZ ELIZUNDIA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 W 69TH ST APT 305
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4585
Mailing Address - Country:US
Mailing Address - Phone:786-908-2602
Mailing Address - Fax:
Practice Address - Street 1:8260 W FLAGLER ST STE 2I
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2069
Practice Address - Country:US
Practice Address - Phone:786-715-9183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022814363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty