Provider Demographics
NPI:1689045809
Name:NIEVES, WILFREDO (APRN)
Entity type:Individual
Prefix:
First Name:WILFREDO
Middle Name:
Last Name:NIEVES
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 1:3942 CRAWLEY DOWN LOOP
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-7134
Mailing Address - Country:US
Mailing Address - Phone:407-314-6625
Mailing Address - Fax:
Practice Address - Street 1:3942 CRAWLEY DOWN LOOP
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-7134
Practice Address - Country:US
Practice Address - Phone:407-314-6625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11035509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPPA809076294OtherBLUE CROSS BLUE SHIELD