MEDICARE: YAMILEN MENGANA BERNAL APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	11037142	FL

General Provider Information

NPI Number	:	1609687946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAMILEN MENGANA BERNAL APRN

Provider Business Mailing Address
First Line	:	12233 SW 24TH TER # 35
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-7309
Country	:	US
Telephone Number	:	786-486-2677
Fax Number	:

Provider Business Practice Location Address
First Line	:	12233 SW 24TH TER # 35
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-7309
Country	:	US
Telephone Number	:	786-486-2677
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2025
Last Update Date	:	01/16/2025

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