Provider Demographics
NPI:1063176683
Name:VILELA, RAQUEL YESENIA (RN)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:YESENIA
Last Name:VILELA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11305 SW 229TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-7564
Mailing Address - Country:US
Mailing Address - Phone:305-510-5959
Mailing Address - Fax:
Practice Address - Street 1:11305 SW 229TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170-7564
Practice Address - Country:US
Practice Address - Phone:305-510-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11017501367500000X
FLRN9435260163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse