Provider Demographics
NPI:1053030205
Name:PONCE, ANIUSKA (NP)
Entity type:Individual
Prefix:
First Name:ANIUSKA
Middle Name:
Last Name:PONCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 GLENEAGLE DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6506
Mailing Address - Country:US
Mailing Address - Phone:786-899-0092
Mailing Address - Fax:
Practice Address - Street 1:6800 GLENEAGLE DR
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6506
Practice Address - Country:US
Practice Address - Phone:305-450-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF07210752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily