Provider Demographics
NPI:1962151597
Name:PAPASTAVROS, MAICKOLL ALEJANDRO (RN, CCRN)
Entity type:Individual
Prefix:MR
First Name:MAICKOLL
Middle Name:ALEJANDRO
Last Name:PAPASTAVROS
Suffix:
Gender:M
Credentials:RN, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 NW 23RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3220
Mailing Address - Country:US
Mailing Address - Phone:305-726-8726
Mailing Address - Fax:
Practice Address - Street 1:918 NW 23RD CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3220
Practice Address - Country:US
Practice Address - Phone:305-726-8726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9338380163WC0200X
FLAPRN11032770367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine