MEDICARE: LETITIA MARIE AYALA APRN, AGACNP-BC

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	390200000X	Student in an Organized Health Care Education/Training Program
2	363LA2100X	Acute Care Nurse Practitioner	11022089	FL

General Provider Information

NPI Number	:	1679234819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LETITIA MARIE AYALA APRN, AGACNP-BC

Provider Business Mailing Address
First Line	:	7593 W BOYNTON BEACH BLVD STE 220
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-6162
Country	:	US
Telephone Number	:	561-678-2652
Fax Number	:

Provider Business Practice Location Address
First Line	:	6080 BOYNTON BEACH BLVD STE 260
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3589
Country	:	US
Telephone Number	:	561-770-7030
Fax Number	:

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

Provider Enumeration Date	:	01/09/2022
Last Update Date	:	01/30/2024

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