Provider Demographics
NPI:1881417012
Name:CONSUEGRA, JOHANDRA M (APRN)
Entity type:Individual
Prefix:MS
First Name:JOHANDRA
Middle Name:M
Last Name:CONSUEGRA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:JOHANDRA
Other - Middle Name:M
Other - Last Name:CONSUEGRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:732 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3339
Mailing Address - Country:US
Mailing Address - Phone:786-804-7736
Mailing Address - Fax:
Practice Address - Street 1:732 E 31ST ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3339
Practice Address - Country:US
Practice Address - Phone:786-804-7736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11036290363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner