Healthcare Provider Details

I. General information

NPI: 1154944106
Provider Name (Legal Business Name): JISELLE SILVA MARRERO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8255 S DIXIE HWY
MIAMI FL
33143-7717
US

IV. Provider business mailing address

4271 SW 143RD AVE
MIRAMAR FL
33027-3052
US

V. Phone/Fax

Practice location:
  • Phone: 786-567-8310
  • Fax:
Mailing address:
  • Phone: 786-395-8143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9411566
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11010441
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: