Provider Demographics
NPI:1699436048
Name:GIRALDO, VIVIAN TATIANA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:TATIANA
Last Name:GIRALDO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:TATIANA
Other - Last Name:GIRALDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:VIVIAN T RODRIGUEZ
Mailing Address - Street 1:12325 SW 105TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-3630
Mailing Address - Country:US
Mailing Address - Phone:305-497-4007
Mailing Address - Fax:
Practice Address - Street 1:12325 SW 105TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-3630
Practice Address - Country:US
Practice Address - Phone:305-497-4007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11017284363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology