MEDICARE: YENISLEN GUTIERREZ VERGEL 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	163W00000X	Registered Nurse	RN9428518	FL
2	363L00000X	Nurse Practitioner	APRN11010152	FL

General Provider Information

NPI Number	:	1356919773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YENISLEN GUTIERREZ VERGEL APRN

Provider Business Mailing Address
First Line	:	4101 RAVENSWOOD RD STE 202
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-5301
Country	:	US
Telephone Number	:	407-485-2182
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 N DOUGLAS RD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-3200
Country	:	US
Telephone Number	:	305-204-0333
Fax Number	:

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

Provider Enumeration Date	:	06/13/2021
Last Update Date	:	03/28/2026

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