MEDICARE: ESSENTIAL GYNECOLOGY

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	363LF0000X	Family Nurse Practitioner
2	363LW0102X	Women's Health Nurse Practitioner

General Provider Information

NPI Number	:	1598629818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSENTIAL GYNECOLOGY

Provider Business Mailing Address
First Line	:	2464 SW 22ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-3419
Country	:	US
Telephone Number	:	786-505-0312
Fax Number	:

Provider Business Practice Location Address
First Line	:	2464 SW 22ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-3419
Country	:	US
Telephone Number	:	786-505-0312
Fax Number	:

Authorized Official
Title or Position	:	NP
Name	:	ROSEANNA BONAVENTURE
Credential	:
Telephone Number	:	786-505-0312

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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