Provider Demographics
NPI:1679145932
Name:FAJARDO, YISEL NEYRA (NP)
Entity type:Individual
Prefix:
First Name:YISEL
Middle Name:NEYRA
Last Name:FAJARDO
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8751 SW 38TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-5457
Mailing Address - Country:US
Mailing Address - Phone:502-810-4249
Mailing Address - Fax:
Practice Address - Street 1:15300 SW 288TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-1355
Practice Address - Country:US
Practice Address - Phone:305-224-6402
Practice Address - Fax:305-628-8345
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11011404363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily