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General NPI Number Information
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NPI Number | 1225956881
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Entity Type | Individual
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Provider Name | ILEANA PETISCO RN
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Gender | Female
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Dates
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Enumeration Date | 07/09/2026
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Last Update Date | 07/09/2026
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Provider Practice Location Address
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Address Line | 13370 SW 131ST ST STE 107
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City | MIAMI
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State | FL
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Zip | 33186-5856
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Country | US
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Telephone | 786-713-0954
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Fax | 786-713-0958
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Provider Business Mailing Address
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Address Line | 13370 SW 131ST ST STE 107
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City | MIAMI
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State | FL
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Zip | 33186-5856
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Country | US
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Telephone | 786-713-0954
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Fax | 786-713-0958
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | RN9310298
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License Number State | FL
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