Healthcare Provider Details

I. General information

NPI: 1760019590
Provider Name (Legal Business Name): VIVIANA ISABEL MANRESA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 W 42ND PL
HIALEAH FL
33012-7610
US

IV. Provider business mailing address

1402 W 42ND PL
HIALEAH FL
33012-7610
US

V. Phone/Fax

Practice location:
  • Phone: 786-299-7223
  • Fax:
Mailing address:
  • Phone: 786-299-7223
  • Fax: 305-847-0709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11006500
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11006500
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: