Healthcare Provider Details

I. General information

NPI: 1861981367
Provider Name (Legal Business Name): MS. NURYS SERPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W 20TH AVE STE 506
HIALEAH FL
33016-1824
US

IV. Provider business mailing address

9010 SW 59TH ST
MIAMI FL
33173-1611
US

V. Phone/Fax

Practice location:
  • Phone: 305-819-1104
  • Fax: 305-819-1107
Mailing address:
  • Phone: 786-247-1946
  • Fax: 305-819-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9457186
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number9457186
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: