Provider Demographics
NPI:1205627684
Name:GONZALEZ NIEVES, YARA LEISYS (FNP)
Entity type:Individual
Prefix:
First Name:YARA
Middle Name:LEISYS
Last Name:GONZALEZ NIEVES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 NW 207TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-1238
Mailing Address - Country:US
Mailing Address - Phone:786-803-1905
Mailing Address - Fax:
Practice Address - Street 1:3600 NW 207TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-1238
Practice Address - Country:US
Practice Address - Phone:786-803-1905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11039397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily