MEDICARE: BEATRIZ BACALLAO RAVELO

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	363LA2200X	Adult Health Nurse Practitioner	11028983	FL
2	363LF0000X	Family Nurse Practitioner	11028983	FL

General Provider Information

NPI Number	:	1598545246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEATRIZ BACALLAO RAVELO

Provider Business Mailing Address
First Line	:	7001 SW 97TH AVE STE 101
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-1407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7001 SW 97TH AVE STE 101
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-1407
Country	:	US
Telephone Number	:	305-273-7998
Fax Number	:

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

Provider Enumeration Date	:	10/02/2023
Last Update Date	:	02/08/2026

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Directions to “ BEATRIZ BACALLAO RAVELO ” Practice Location

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