MEDICARE: MELANIO EMILIO BRUCETA FERRER 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11010530	FL
2	363LF0000X	Family Nurse Practitioner	11010530	FL

General Provider Information

NPI Number	:	1689260549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIO EMILIO BRUCETA FERRER ARNP

Provider Business Mailing Address
First Line	:	5731 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-2756
Country	:	US
Telephone Number	:	305-409-9192
Fax Number	:

Provider Business Practice Location Address
First Line	:	8080 PASADENA BLVD STE A
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-3537
Country	:	US
Telephone Number	:	954-437-9070
Fax Number	:	954-437-8193

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

Provider Enumeration Date	:	12/15/2020
Last Update Date	:	10/02/2024

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