Provider Demographics
NPI:1760007546
Name:VELASCO PENA, DAVID YUNIOR (APRN)
Entity Type:Individual
Prefix:
First Name:DAVID YUNIOR
Middle Name:
Last Name:VELASCO PENA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8888 NW 118TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1987
Mailing Address - Country:US
Mailing Address - Phone:786-273-2584
Mailing Address - Fax:
Practice Address - Street 1:3255 FOREST HILL BLVD STE 103
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5854
Practice Address - Country:US
Practice Address - Phone:561-964-4577
Practice Address - Fax:561-964-4572
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11007439363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily