Individual provider Active NPI

Andres Rodolfo Boucugnani Estrada, APRN

  • Family Nurse Practitioner
  • Miami, FL
National Provider Identifier
1760244172
Registry record updated Jan 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11030578 Issued in FL
Practice address
12640 SW 77TH St
Miami, FL 33183-3518
Phone
(786) 343-9061
NPI assigned
Jan 30, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11030578 FL Primary

Addresses

Primary practice location

12640 SW 77TH St
Miami, FL 33183-3518

Mailing address

12640 SW 77TH St
Miami, FL 33183-3518

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241016001923 FL Practitioner - Nurse Practitioner 8820520760 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11030578FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Clinica Las Mercedes, LLC CurrentSince Nov 1, 2024 Accepting new patients
Clinica Las Mercedes, LLC CurrentSince Nov 1, 2024 Accepting new patients

Locations

1479 NW 27th Ave
Miami, FL 33125
Phone (305) 633-3776

6355 NW 36th St
Ste 1100
Virginia Gardens, FL 33166

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1706572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1760244172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12640 SW 77TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331833518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12640 SW 77TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331833518",
            "telephone_number": "786-343-9061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCUGNANI ESTRADA",
        "first_name": "ANDRES",
        "middle_name": "RODOLFO",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-01-30",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11030578",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.