Provider Demographics
NPI:1386437028
Name:RAVELO, LUIS JOEL (APRN)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:JOEL
Last Name:RAVELO
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 1:11920 SW 184TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2462
Mailing Address - Country:US
Mailing Address - Phone:786-608-4955
Mailing Address - Fax:
Practice Address - Street 1:4960 SW 72ND AVE STE 303
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5550
Practice Address - Country:US
Practice Address - Phone:305-591-1606
Practice Address - Fax:305-591-1618
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11039433363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily