Provider Demographics
NPI:1588377337
Name:MARTIN PACHECO, YUSEL (APRN)
Entity type:Individual
Prefix:
First Name:YUSEL
Middle Name:
Last Name:MARTIN PACHECO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5581 NW 200TH LN LOT 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-6627
Mailing Address - Country:US
Mailing Address - Phone:786-427-3809
Mailing Address - Fax:
Practice Address - Street 1:8352 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3354
Practice Address - Country:US
Practice Address - Phone:305-225-0707
Practice Address - Fax:888-208-1644
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-26
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023561363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty