Healthcare Provider Details

I. General information

NPI: 1558282699
Provider Name (Legal Business Name): YVANE VILSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11905 W BISCAYNE CANAL RD
NORTH MIAMI FL
33161-6138
US

IV. Provider business mailing address

11905 W BISCAYNE CANAL RD
NORTH MIAMI FL
33161-6138
US

V. Phone/Fax

Practice location:
  • Phone: 786-419-6902
  • Fax:
Mailing address:
  • Phone: 786-419-6902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN1112931
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: