Healthcare Provider Details

I. General information

NPI: 1962288548
Provider Name (Legal Business Name): ANISLEY SOSA LLULL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 8
CAROLINA PR
00986-0008
US

IV. Provider business mailing address

4515 SW 116TH AVE
MIAMI FL
33165-5535
US

V. Phone/Fax

Practice location:
  • Phone: 787-626-3322
  • Fax:
Mailing address:
  • Phone: 786-635-7972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11028337
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17299I
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: