Healthcare Provider Details

I. General information

NPI: 1124894670
Provider Name (Legal Business Name): YANET GARRIDO COUTIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 NW 84TH AVE
SUNRISE FL
33351-6607
US

IV. Provider business mailing address

3505 NW 84TH AVE
SUNRISE FL
33351-6607
US

V. Phone/Fax

Practice location:
  • Phone: 954-748-3039
  • Fax: 866-247-5394
Mailing address:
  • Phone: 954-748-3039
  • Fax: 866-247-5394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11029466
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: