Healthcare Provider Details

I. General information

NPI: 1942712013
Provider Name (Legal Business Name): YAIMA FAJARDO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YAIMA FAJARDO ARNP

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 10/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 NW 171ST ST
HIALEAH FL
33015-3738
US

IV. Provider business mailing address

8210 NW 171ST ST
HIALEAH FL
33015-3738
US

V. Phone/Fax

Practice location:
  • Phone: 786-553-3484
  • Fax:
Mailing address:
  • Phone: 786-553-3484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9338134
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: