MEDICARE: YENY BLANCO 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	363LF0000X	Family Nurse Practitioner	APRN11009111	FL
2	163WM0102X	Maternal Newborn Registered Nurse	9304791	FL

General Provider Information

NPI Number	:	1710591029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YENY BLANCO APRN

Provider Business Mailing Address
First Line	:	2944 SW 18TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-1916
Country	:	US
Telephone Number	:	786-252-2860
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 W 68TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-1801
Country	:	US
Telephone Number	:	786-252-2860
Fax Number	:

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

Provider Enumeration Date	:	09/03/2020
Last Update Date	:	12/18/2020

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