MEDICARE: MRS. ZAYRA IVELISSE REILLY ARNP

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	RN9168898	FL

General Provider Information

NPI Number	:	1891177846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ZAYRA IVELISSE REILLY ARNP

Provider Business Mailing Address
First Line	:	16801 NW 67TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-4203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16801 NW 67TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-4203
Country	:	US
Telephone Number	:	305-822-9522
Fax Number	:

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

Provider Enumeration Date	:	06/26/2015
Last Update Date	:	04/21/2016

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