Provider Demographics
NPI:1730632704
Name:VELASQUEZ, MAIRA YAMILETH (FNP, DNP)
Entity type:Individual
Prefix:
First Name:MAIRA
Middle Name:YAMILETH
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:FNP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17107 N BAY RD
Mailing Address - Street 2:APT. C-505
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4085
Mailing Address - Country:US
Mailing Address - Phone:305-900-9175
Mailing Address - Fax:
Practice Address - Street 1:17107 N BAY RD
Practice Address - Street 2:APT. C-505
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4085
Practice Address - Country:US
Practice Address - Phone:305-900-9175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLV422559889630363LF0000X
FLAPRN9328517363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily