Healthcare Provider Details

I. General information

NPI: 1558173476
Provider Name (Legal Business Name): MELISSA LLANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 NW 159TH ST
OPA LOCKA FL
33054-6836
US

IV. Provider business mailing address

3030 NW 159TH ST
OPA LOCKA FL
33054-6836
US

V. Phone/Fax

Practice location:
  • Phone: 305-542-2896
  • Fax:
Mailing address:
  • Phone: 305-542-2896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11036162
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: