Healthcare Provider Details

I. General information

NPI: 1851857163
Provider Name (Legal Business Name): CRISTHIAN A YSEA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11645 BISCAYNE BLVD STE 405
MIAMI FL
33181-3139
US

IV. Provider business mailing address

11645 BISCAYNE BLVD STE 207
NORTH MIAMI FL
33181-3138
US

V. Phone/Fax

Practice location:
  • Phone: 305-538-8835
  • Fax: 305-994-0054
Mailing address:
  • Phone: 305-538-8835
  • Fax: 305-994-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11000914
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: