Healthcare Provider Details

I. General information

NPI: 1730787979
Provider Name (Legal Business Name): JENIFFER VIZOSO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2020
Last Update Date: 08/26/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 14TH AVE STE 550
BROOKLYN NY
11218-3773
US

IV. Provider business mailing address

10850 W FLAGLER ST APT D315
MIAMI FL
33174-1464
US

V. Phone/Fax

Practice location:
  • Phone: 718-819-6144
  • Fax: 718-819-6145
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11009590
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348681
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: