Healthcare Provider Details

I. General information

NPI: 1598432825
Provider Name (Legal Business Name): YUISY OBREGON REYES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 08/25/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17210 NW 33RD CT
MIAMI GARDENS FL
33056-4217
US

IV. Provider business mailing address

17210 NW 33RD CT
MIAMI GARDENS FL
33056-4217
US

V. Phone/Fax

Practice location:
  • Phone: 786-294-1202
  • Fax: 305-962-8879
Mailing address:
  • Phone: 786-294-1202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11014351
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: