| Doctor Name: | PRISCILLA VIDAL |
| NPI Number: | 1043209869 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | ARNP9181414 |
| Business Practice Address: | 21097 Ne 27th Ct Suite 205 Aventura, FL - 331801204 |
| Business Phone Number: | 3056829877 |
| Business Fax Number: | 3056821602 |
| Mailing Address: | 4620 N State Road 7, Ste 316 LAUDERDALE LAKES |
| State: | FL |
| Postal Code: | 333195884 |
| Phone Number: | 9549676400 |
| Fax Number: | 9549657339 |
| NPI Enumeration Date: | 10/14/2005 |
| NPI Last Update Date: | 01/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | ARNP9181414 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |