Provider Demographics
NPI:1992751085
Name:ANDUJAR, EMILLY R (ARNP)
Entity type:Individual
Prefix:
First Name:EMILLY
Middle Name:R
Last Name:ANDUJAR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1846
Mailing Address - Country:US
Mailing Address - Phone:305-575-1776
Mailing Address - Fax:305-575-1780
Practice Address - Street 1:4685 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2132
Practice Address - Country:US
Practice Address - Phone:305-661-2534
Practice Address - Fax:305-667-7451
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3414702363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2527ZMedicare ID - Type Unspecified
FLQ15653Medicare UPIN