MEDICARE: MRS. MAYRA A PERROTTA 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	363L00000X	Nurse Practitioner	APRN9294240	FL
2	363LA2100X	Acute Care Nurse Practitioner	APRN9294240	FL

General Provider Information

NPI Number	:	1982030052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAYRA A PERROTTA ARNP

Provider Business Mailing Address
First Line	:	11479 NW 4TH LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33172-4964
Country	:	US
Telephone Number	:	786-547-8043
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 NW 79TH AVE
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33122-1174
Country	:	US
Telephone Number	:	305-585-8342
Fax Number	:

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

Provider Enumeration Date	:	09/20/2013
Last Update Date	:	10/16/2023

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