Healthcare Provider Details

I. General information

NPI: 1871205260
Provider Name (Legal Business Name): YEZENIA CHANTEL PEREIRA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 06/24/2026
Certification Date: 12/17/2022
Deactivation Date: 07/15/2025
Reactivation Date: 06/24/2026

III. Provider practice location address

17546 SW 153RD AVE
MIAMI FL
33187-1439
US

IV. Provider business mailing address

17546 SW 153RD AVE
MIAMI FL
33187-1439
US

V. Phone/Fax

Practice location:
  • Phone: 786-209-6040
  • Fax:
Mailing address:
  • Phone: 786-209-6040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11023530
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11023530
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11023530
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11023530
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: