Provider Demographics
NPI:1710628151
Name:AMADOR ROSA, YARELIS
Entity Type:Individual
Prefix:
First Name:YARELIS
Middle Name:
Last Name:AMADOR ROSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9960 NW 116TH WAY STE 13
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1175
Mailing Address - Country:US
Mailing Address - Phone:561-788-7545
Mailing Address - Fax:561-556-1216
Practice Address - Street 1:8720 N KENDALL DR STE 211
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2198
Practice Address - Country:US
Practice Address - Phone:305-273-3007
Practice Address - Fax:305-273-3913
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11017344363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily