MEDICARE: FAILLON EMMANUEL BSN,RN

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1346166949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAILLON EMMANUEL BSN,RN

Provider Business Mailing Address
First Line	:	1498 NE 178TH ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-1339
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 NW 12TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33136-1096
Country	:	US
Telephone Number	:	305-585-6064
Fax Number	:

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

Provider Enumeration Date	:	06/26/2026
Last Update Date	:	06/26/2026

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