Provider Demographics
NPI:1689428526
Name:LEDESMA, LUZ REINA (APRN)
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:REINA
Last Name:LEDESMA
Suffix:
Gender:
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:PO BOX 961237
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33296-1237
Mailing Address - Country:US
Mailing Address - Phone:305-763-0148
Mailing Address - Fax:
Practice Address - Street 1:1150 NW 72ND AVE
Practice Address - Street 2:TOWER 1 STE. 455
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-4216
Practice Address - Country:US
Practice Address - Phone:786-707-7135
Practice Address - Fax:330-355-5013
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11032278363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty