=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427773985
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ISHBEL PAOLA SERRANO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2022
-----------------------------------------------------
Last Update Date | 10/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 COND SAN FERNANDO VLG APT 226
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00987-6959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 689-252-0234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2599 EAGLE BAY BLVD
-----------------------------------------------------
City | KISSIMMEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34743-6093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 689-252-0234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WI0500X
-----------------------------------------------------
Taxonomy Name | Infusion Therapy Registered Nurse
-----------------------------------------------------
License Number | RN9498240
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------