Provider Demographics
NPI:1972085512
Name:BLANCO LABORI, YADIRA (ARNP)
Entity Type:Individual
Prefix:
First Name:YADIRA
Middle Name:
Last Name:BLANCO LABORI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20013 NW 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6614
Mailing Address - Country:US
Mailing Address - Phone:786-319-6697
Mailing Address - Fax:
Practice Address - Street 1:4218 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-2306
Practice Address - Country:US
Practice Address - Phone:305-266-2929
Practice Address - Fax:786-558-0242
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9411561363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily