Healthcare Provider Details

I. General information

NPI: 1558102749
Provider Name (Legal Business Name): HOMERO BERNAL SANTOS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 W FLAGLER ST STE 2I
MIAMI FL
33144-2069
US

IV. Provider business mailing address

616 NW 26TH AVE APT 211
MIAMI FL
33125-3045
US

V. Phone/Fax

Practice location:
  • Phone: 867-715-9183
  • Fax: 786-713-1115
Mailing address:
  • Phone: 305-926-2826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11033152
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: