Provider Demographics
NPI:1144933797
Name:OTANO, DAMIAN FRANCHESCO (FNP-BC)
Entity type:Individual
Prefix:
First Name:DAMIAN
Middle Name:FRANCHESCO
Last Name:OTANO
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3431 NE 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3981
Mailing Address - Country:US
Mailing Address - Phone:786-527-2693
Mailing Address - Fax:786-527-2692
Practice Address - Street 1:3431 NE 1ST AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3981
Practice Address - Country:US
Practice Address - Phone:786-527-2693
Practice Address - Fax:786-527-2692
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2022091346363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner