Healthcare Provider Details

I. General information

NPI: 1710628151
Provider Name (Legal Business Name): YARELIS AMADOR ROSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8720 N KENDALL DR STE 211
MIAMI FL
33176-2198
US

IV. Provider business mailing address

9960 NW 116TH WAY STE 13
MEDLEY FL
33178-1175
US

V. Phone/Fax

Practice location:
  • Phone: 305-273-3007
  • Fax: 305-273-3913
Mailing address:
  • Phone: 561-788-7545
  • Fax: 561-556-1216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11017344
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: