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General NPI Number Information
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NPI Number | 1629968649
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Entity Type | Individual
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Provider Name | BERNARDO REVILLA FIOL APRN, MSN, PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 5190 NW 167TH ST STE 201
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City | MIAMI LAKES
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State | FL
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Zip | 33014-6338
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Country | US
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Telephone | 305-705-4289
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Fax |
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Provider Business Mailing Address
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Address Line | 7972 PINES BLVD UNIT 245866
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-8647
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Country | US
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Telephone | 786-849-0033
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11040786
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License Number State | FL
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