Provider Demographics
NPI:1770210650
Name:GARCIA PENA, YOANNIA
Entity type:Individual
Prefix:
First Name:YOANNIA
Middle Name:
Last Name:GARCIA PENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-6036
Mailing Address - Country:US
Mailing Address - Phone:305-246-4740
Mailing Address - Fax:
Practice Address - Street 1:450 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-6036
Practice Address - Country:US
Practice Address - Phone:305-246-4740
Practice Address - Fax:305-246-4745
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9268339163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse