MEDICARE: YUMIRVA JOSEFINA BALBAS 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	363LP2300X	Primary Care Nurse Practitioner	11018240	FL

General Provider Information

NPI Number	:	1992440580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUMIRVA JOSEFINA BALBAS APRN

Provider Business Mailing Address
First Line	:	20860 SAN SIMEON WAY APT 206
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-1809
Country	:	US
Telephone Number	:	786-296-7519
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 HARRISON ST # 18D
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-6829
Country	:	US
Telephone Number	:	786-296-7519
Fax Number	:

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

Provider Enumeration Date	:	04/28/2022
Last Update Date	:	04/28/2022

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