MEDICARE: YULEIMA PLACENCIA GONZALEZ APRN

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	9454691	FL
2	363LW0102X	Women's Health Nurse Practitioner	9454691	FL
3	363LP2300X	Primary Care Nurse Practitioner	9454691	FL

General Provider Information

NPI Number	:	1720555121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YULEIMA PLACENCIA GONZALEZ APRN

Provider Business Mailing Address
First Line	:	3905 NW 107TH AVE STE 409
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33178-2785
Country	:	US
Telephone Number	:	786-953-1774
Fax Number	:	689-303-3268

Provider Business Practice Location Address
First Line	:	3905 NW 107TH AVE STE 409
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33178-2785
Country	:	US
Telephone Number	:	786-953-1774
Fax Number	:	689-303-3268

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

Provider Enumeration Date	:	10/24/2018
Last Update Date	:	04/05/2024

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