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Organization
ILAVANDERA APRN LLC
Active
Organization
ILAVANDERA APRN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IVAN LAVANDERA RODRIGUEZ APRN (AUTHORIZED OFFICIAL)
(716) 423-3042
Entity
Organization
Contact information
Practice address
11654 SW 142ND PL, MIAMI, FL 33186-8607
(716) 423-3042
Mailing address
11654 SW 142ND PL, MIAMI, FL 33186-8607
(716) 423-3042
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LICENSE
11012290
FL
Enumeration date
12/12/2022
Last updated
12/12/2022
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