Healthcare Provider Details

I. General information

NPI: 1164148474
Provider Name (Legal Business Name): MANUEL VERGARA YEE III FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14091 SW 157TH CT
MIAMI FL
33196-6746
US

IV. Provider business mailing address

14091 SW 157TH CT
MIAMI FL
33196-6746
US

V. Phone/Fax

Practice location:
  • Phone: 305-562-8435
  • Fax:
Mailing address:
  • Phone: 305-562-8435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11022340
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: