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General NPI Number Information
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NPI Number | 1689345795
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Entity Type | Individual
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Provider Name | MAYRA CARMEN COSME APRN
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Gender | Female
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Dates
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Enumeration Date | 09/28/2021
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 4160 W 16TH AVE STE 506
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City | HIALEAH
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State | FL
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Zip | 33012-5884
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Country | US
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Telephone | 305-819-4432
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Fax | 305-819-3764
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Provider Business Mailing Address
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Address Line | 20448 SW 93RD AVE
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City | CUTLER BAY
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State | FL
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Zip | 33189-3210
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Country | US
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Telephone | 305-431-9067
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | APRN11023634
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9292569
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License Number State | FL
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