Provider Demographics
NPI:1689345795
Name:COSME, MAYRA CARMEN (APRN)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:CARMEN
Last Name:COSME
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MAYRA
Other - Middle Name:DEL CARMEN
Other - Last Name:COSME
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:20448 SW 93RD AVE
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3210
Mailing Address - Country:US
Mailing Address - Phone:305-431-9067
Mailing Address - Fax:
Practice Address - Street 1:4160 W 16TH AVE STE 506
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5884
Practice Address - Country:US
Practice Address - Phone:305-819-4432
Practice Address - Fax:305-819-3764
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11023634207Q00000X
FLRN9292569163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine