Provider Demographics
NPI:1609661685
Name:RIQUELME, TATIANA (FNP-C)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:RIQUELME
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 SW 13TH ST APT 332
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-4301
Mailing Address - Country:US
Mailing Address - Phone:786-202-1609
Mailing Address - Fax:
Practice Address - Street 1:7150 W 20TH AVE STE 304
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5532
Practice Address - Country:US
Practice Address - Phone:305-512-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9446018163W00000X
FLAPRN11035232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse