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General NPI Number Information
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NPI Number | 1063848356
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Entity Type | Individual
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Provider Name | YENNY M CEBALLOS ARNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/19/2013
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 5975 SUNSET DR STE 402
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5198
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Country | US
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Telephone | 305-968-1996
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Fax |
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Provider Business Mailing Address
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Address Line | 12944 SW 222ND STREET
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City | MIAMI
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State | FL
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Zip | 33170
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Country | US
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Telephone | 305-968-1996
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9264957
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License Number State | FL
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