Provider Demographics
NPI:1285472795
Name:REBURIANO, MINA SERENA MANAOG (APRN)
Entity type:Individual
Prefix:
First Name:MINA SERENA
Middle Name:MANAOG
Last Name:REBURIANO
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 W CRYSTAL DOWNS PATH
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-7824
Mailing Address - Country:US
Mailing Address - Phone:929-423-6782
Mailing Address - Fax:
Practice Address - Street 1:10489 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:CITRUS SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34434-3268
Practice Address - Country:US
Practice Address - Phone:352-489-2486
Practice Address - Fax:352-489-5786
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9522281163W00000X
FL11035516363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse