Healthcare Provider Details

I. General information

NPI: 1508606526
Provider Name (Legal Business Name): MAYRA ALEJANDRA RENDEROS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAYRA ALEJANDRA TERRERO

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

988 HILL FLOWER DR
BROOKSVILLE FL
34604-1477
US

IV. Provider business mailing address

7901 4TH ST N STE 300
ST PETERSBURG FL
33702-4399
US

V. Phone/Fax

Practice location:
  • Phone: 813-240-1218
  • Fax:
Mailing address:
  • Phone: 813-240-1218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number9369176
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11033206
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: