Healthcare Provider Details

I. General information

NPI: 1811787948
Provider Name (Legal Business Name): AMARILIS PENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12039 ORANGE BLVD
WEST PALM BEACH FL
33412-1417
US

IV. Provider business mailing address

12039 ORANGE BLVD
WEST PALM BEACH FL
33412-1417
US

V. Phone/Fax

Practice location:
  • Phone: 561-631-5512
  • Fax: 561-631-5512
Mailing address:
  • Phone: 561-631-5512
  • Fax: 561-631-5512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9699458
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2939-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: