Provider Demographics
NPI:1972925253
Name:QUINDEMIL, KETTYELENA
Entity type:Individual
Prefix:
First Name:KETTYELENA
Middle Name:
Last Name:QUINDEMIL
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 1:321 SW 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1640
Mailing Address - Country:US
Mailing Address - Phone:786-271-4973
Mailing Address - Fax:
Practice Address - Street 1:321 SW 120TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1640
Practice Address - Country:US
Practice Address - Phone:786-271-4973
Practice Address - Fax:862-714-9737
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9274074367500000X
FLARNP9274074367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered