Healthcare Provider Details

I. General information

NPI: 1508656976
Provider Name (Legal Business Name): YERENIS LLANES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15535 MIAMI LAKEWAY N APT 101
MIAMI LAKES FL
33014-5545
US

IV. Provider business mailing address

15535 MIAMI LAKEWAY N APT 101
MIAMI LAKES FL
33014-5545
US

V. Phone/Fax

Practice location:
  • Phone: 786-263-1967
  • Fax:
Mailing address:
  • Phone: 786-263-1967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11039207
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: