MEDICARE: INDHIRA Y PENA RN

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	RN9710627	FL
2	246ZC0007X	Surgical Assistant	19-361	FL

General Provider Information

NPI Number	:	1629696786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INDHIRA Y PENA RN

Provider Business Mailing Address
First Line	:	415 NW 109TH AVE
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33026-4056
Country	:	US
Telephone Number	:	954-398-0347
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 NW 109TH AVE
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33026-4056
Country	:	US
Telephone Number	:	954-398-0347
Fax Number	:

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

Provider Enumeration Date	:	07/06/2020
Last Update Date	:	06/02/2026

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