MEDICARE: JANET REVILLA ARNP

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	363L00000X	Nurse Practitioner	ARNP2811312	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528329943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET REVILLA ARNP

Provider Business Mailing Address
First Line	:	1700 NW 49TH ST STE 125
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3750
Country	:	US
Telephone Number	:	954-217-5700
Fax Number	:	954-217-5704

Provider Business Practice Location Address
First Line	:	2300 N COMMERCE PKWY STE 103
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-3255
Country	:	US
Telephone Number	:	954-217-5700
Fax Number	:	954-217-5704

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

Provider Enumeration Date	:	06/01/2012
Last Update Date	:	10/30/2019

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Directions to “ JANET REVILLA ARNP” Practice Location

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