Provider Demographics
NPI:1992303101
Name:REYES NIEVES, ROBERTO (APRN)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:REYES NIEVES
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14221 SW 120TH ST STE 129
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7463
Mailing Address - Country:US
Mailing Address - Phone:786-292-9650
Mailing Address - Fax:786-420-3240
Practice Address - Street 1:14221 SW 120TH ST STE 129
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7463
Practice Address - Country:US
Practice Address - Phone:862-929-6507
Practice Address - Fax:786-420-3240
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL100985171M00000X
FL11024706363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No171M00000XOther Service ProvidersCase Manager/Care Coordinator