Healthcare Provider Details

I. General information

NPI: 1316396146
Provider Name (Legal Business Name): YANISETT RIZO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 SW 74TH ST STE 211
MIAMI FL
33143-5150
US

IV. Provider business mailing address

5901 SW 74TH ST STE 211
MIAMI FL
33143-5150
US

V. Phone/Fax

Practice location:
  • Phone: 305-457-8021
  • Fax:
Mailing address:
  • Phone: 305-457-8021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11042481
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: