Healthcare Provider Details

I. General information

NPI: 1558905596
Provider Name (Legal Business Name): YUMY QUINTANA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2019
Last Update Date: 11/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16151 SW 61ST LN
MIAMI FL
33193-5804
US

IV. Provider business mailing address

16151 SW 61ST LN
MIAMI FL
33193-5804
US

V. Phone/Fax

Practice location:
  • Phone: 786-291-2065
  • Fax:
Mailing address:
  • Phone: 786-291-2065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9393148
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: