MEDICARE: YARISNEISY 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	363LF0000X	Family Nurse Practitioner	11000291	FL

General Provider Information

NPI Number	:	1912477472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YARISNEISY GONZALEZ APRN

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	305-500-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4090 S RIDGEWOOD AVE
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4501
Country	:	US
Telephone Number	:	386-280-7251
Fax Number	:

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

Provider Enumeration Date	:	11/27/2018
Last Update Date	:	02/17/2026

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