MEDICARE: BAYOLET REDONDO 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	RN9421401	FL
2	363L00000X	Nurse Practitioner	APRN11020875	FL

General Provider Information

NPI Number	:	1417677550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAYOLET REDONDO APRN

Provider Business Mailing Address
First Line	:	10716 NW 87TH CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4610
Country	:	US
Telephone Number	:	786-280-9032
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 SW 3RD AVE STE 600
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33129-2338
Country	:	US
Telephone Number	:	786-280-9032
Fax Number	:

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

Provider Enumeration Date	:	08/30/2022
Last Update Date	:	08/30/2022

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Directions to “ BAYOLET REDONDO APRN” Practice Location

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