Healthcare Provider Details

I. General information

NPI: 1790956340
Provider Name (Legal Business Name): MAYUKO NAKANISHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 SW 109TH AVE #226
MIAMI FL
33173-4455
US

IV. Provider business mailing address

7490 SW 86TH WAY
GAINESVILLE FL
32608-8432
US

V. Phone/Fax

Practice location:
  • Phone: 305-412-2386
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9170471
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9170471
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: