Provider Demographics
NPI:1568256741
Name:CANOSA LEBRIGIO, ELIANYS
Entity type:Individual
Prefix:
First Name:ELIANYS
Middle Name:
Last Name:CANOSA LEBRIGIO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 NW 171ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-4535
Mailing Address - Country:US
Mailing Address - Phone:786-879-4587
Mailing Address - Fax:
Practice Address - Street 1:3850 NW 171ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-4535
Practice Address - Country:US
Practice Address - Phone:786-879-4587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11038716363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty