MEDICARE: NEDELIS C. BUELA ARNP, AGNP

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	363LA2200X	Adult Health Nurse Practitioner	AG05170038	FL
2	363LG0600X	Gerontology Nurse Practitioner	AG05170038	FL
3	363L00000X	Nurse Practitioner	9291427	FL

General Provider Information

NPI Number	:	1265953756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEDELIS C. BUELA ARNP, AGNP

Provider Business Mailing Address
First Line	:	8741 NW 145TH TER
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33018-8017
Country	:	US
Telephone Number	:	786-443-4767
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 DAVIE BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-3029
Country	:	US
Telephone Number	:	754-216-2458
Fax Number	:	954-734-6750

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

Provider Enumeration Date	:	07/05/2017
Last Update Date	:	09/03/2019

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