Healthcare Provider Details

I. General information

NPI: 1497571509
Provider Name (Legal Business Name): JENNY ANGELICA BENAVIDES YUGCHA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20215 NW 2ND AVE STE 1
MIAMI GARDENS FL
33169-2538
US

IV. Provider business mailing address

8333 NW 53RD ST FL 6
DORAL FL
33166-4783
US

V. Phone/Fax

Practice location:
  • Phone: 786-949-6322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11036992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: