Provider Demographics
NPI:1588364053
Name:PARK, EMMA LEE (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:LEE
Last Name:PARK
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 NE 2ND AVE # 104
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33161-6628
Mailing Address - Country:US
Mailing Address - Phone:305-899-3750
Mailing Address - Fax:305-899-3751
Practice Address - Street 1:11300 NE 2ND AVE # 104
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33161-6628
Practice Address - Country:US
Practice Address - Phone:305-899-3750
Practice Address - Fax:305-899-3751
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11022833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily