Healthcare Provider Details

I. General information

NPI: 1568002400
Provider Name (Legal Business Name): YENISLEIMIS C FERNANDEZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 NW 12TH AVE
MIAMI FL
33136-1002
US

IV. Provider business mailing address

8375 NW 53RD TER # 781
DORAL FL
33166-4851
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-1000
  • Fax:
Mailing address:
  • Phone: 305-689-8375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN-11006029
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: