Provider Demographics
NPI:1780469759
Name:JUNCADELLA, PRISCILLA MERCY (APRN)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:MERCY
Last Name:JUNCADELLA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 SW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1033
Mailing Address - Country:US
Mailing Address - Phone:305-216-0148
Mailing Address - Fax:
Practice Address - Street 1:8600 SW 21ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1033
Practice Address - Country:US
Practice Address - Phone:305-216-0148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11028325363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health