Provider Demographics
NPI:1942317227
Name:DUBUISSON, MYRLANDE (CPN)
Entity Type:Individual
Prefix:MRS
First Name:MYRLANDE
Middle Name:
Last Name:DUBUISSON
Suffix:
Gender:F
Credentials:CPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 SW 143RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3049
Mailing Address - Country:US
Mailing Address - Phone:954-431-2140
Mailing Address - Fax:
Practice Address - Street 1:16161 NW 57TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6707
Practice Address - Country:US
Practice Address - Phone:305-625-3409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1812982363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305721600Medicaid