Healthcare Provider Details

I. General information

NPI: 1093138083
Provider Name (Legal Business Name): ARACELIS WYNN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 BONAVENTURE BLVD
WESTON FL
33326-4039
US

IV. Provider business mailing address

1608 SE 3RD AVENUE THIRD FLOOR PBO
FORT LAUDERDALE FL
33316-2564
US

V. Phone/Fax

Practice location:
  • Phone: 954-385-0014
  • Fax:
Mailing address:
  • Phone: 954-320-3323
  • Fax: 954-753-6377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9235724
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9235724
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: