Provider Demographics
NPI:1407252885
Name:BARCELO, YANETTE (PA)
Entity Type:Individual
Prefix:
First Name:YANETTE
Middle Name:
Last Name:BARCELO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11760 BIRD RD
Mailing Address - Street 2:SUITE 451
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3582
Mailing Address - Country:US
Mailing Address - Phone:305-227-9233
Mailing Address - Fax:
Practice Address - Street 1:11760 BIRD RD
Practice Address - Street 2:SUITE 451
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3582
Practice Address - Country:US
Practice Address - Phone:305-227-9233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-12
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108126363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9108126OtherMEDICAL LICENSE