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General NPI Number Information
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NPI Number | 1356919773
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Entity Type | Individual
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Provider Name | YENISLEN GUTIERREZ VERGEL APRN
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Gender | Female
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Dates
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Enumeration Date | 06/13/2021
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Last Update Date | 04/08/2024
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Provider Practice Location Address
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Address Line | 1800 N DOUGLAS RD
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-3200
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Country | US
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Telephone | 305-204-0333
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Fax |
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Provider Business Mailing Address
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Address Line | 2328 S CONGRESS AVE STE 1E
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City | PALM SPRINGS
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State | FL
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Zip | 33406-7671
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Country | US
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Telephone | 407-485-2182
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9428518
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11010152
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License Number State | FL
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