Basic Information
| Provider Information | |||||||||
| NPI: | 1902058415 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEPIOLA | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | REGINA | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19559 NE 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | N MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331793501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056513261 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16401 NW 2ND AVE | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | N MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331696036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059990009 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2008 | ||||||||
| LastUpdateDate: | 01/26/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 1328792 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.