Provider Demographics
NPI:1538858014
Name:ANDRIA PENA COEGO NP LLC
Entity type:Organization
Organization Name:ANDRIA PENA COEGO NP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA COEGO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-720-2336
Mailing Address - Street 1:8307 SW 142ND AVE APT E104
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4011
Mailing Address - Country:US
Mailing Address - Phone:786-720-2336
Mailing Address - Fax:
Practice Address - Street 1:8307 SW 142ND AVE APT E104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4011
Practice Address - Country:US
Practice Address - Phone:786-720-2336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty