MEDICARE: YANELIS DE LEON GONZALEZ APRN

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	11043384	FL

General Provider Information

NPI Number	:	1336723659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YANELIS DE LEON GONZALEZ APRN

Provider Business Mailing Address
First Line	:	8840 W LONG ACRE DR
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-2742
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8840 W LONG ACRE DR
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-2742
Country	:	US
Telephone Number	:	305-978-1874
Fax Number	:

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

Provider Enumeration Date	:	05/12/2021
Last Update Date	:	11/22/2025

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