Provider Demographics
NPI:1992228712
Name:PENA COTUI, NAYROBI MAITELIC (MD)
Entity type:Individual
Prefix:
First Name:NAYROBI
Middle Name:MAITELIC
Last Name:PENA COTUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100289
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0277
Mailing Address - Country:US
Mailing Address - Phone:352-273-9804
Mailing Address - Fax:352-392-6481
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-7606
Practice Address - Country:US
Practice Address - Phone:352-273-9804
Practice Address - Fax:352-392-6481
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME156594207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114603000Medicaid