MEDICARE: YANA NICOLE BLAISE RN, FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN0000162414	TN
2	363LF0000X	Family Nurse Practitioner	ARNP9278753	FL

General Provider Information

NPI Number	:	1083859789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YANA NICOLE BLAISE RN, FNP

Provider Business Mailing Address
First Line	:	3640 GRAND AVE
Second Line	:
City	:	COCONUT GROVE
State	:	FL
Zip	:	33133-4953
Country	:	US
Telephone Number	:	305-446-5917
Fax Number	:	305-446-0712

Provider Business Practice Location Address
First Line	:	486 FISHERMAN ST
Second Line	:
City	:	OPA LOCKA
State	:	FL
Zip	:	33054-3818
Country	:	US
Telephone Number	:	305-688-5456
Fax Number	:	305-688-1661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2008
Last Update Date	:	04/11/2024

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