Healthcare Provider Details

I. General information

NPI: 1821178658
Provider Name (Legal Business Name): GUYLENE LACOMBE KERNISANT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 SW 211 STREET
MIAMI FL
33189
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 400
MIAMI FL
33126-2051
US

V. Phone/Fax

Practice location:
  • Phone: 305-254-1500
  • Fax: 305-254-1518
Mailing address:
  • Phone: 305-500-2009
  • Fax: 305-500-2145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 1950172
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: