Provider Demographics
NPI:1285203331
Name:VIGUERA RICARDO, YANELA (APRN)
Entity type:Individual
Prefix:
First Name:YANELA
Middle Name:
Last Name:VIGUERA RICARDO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:YANELA
Other - Middle Name:
Other - Last Name:VIGUERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:4733 W WATERS AVE APT 1527
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1462
Mailing Address - Country:US
Mailing Address - Phone:813-863-2480
Mailing Address - Fax:
Practice Address - Street 1:910 OAKFIELD DR STE 102
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4925
Practice Address - Country:US
Practice Address - Phone:813-681-4413
Practice Address - Fax:813-684-7299
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11009918363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11009918OtherSTATE LICENSE