Provider Demographics
NPI:1740713460
Name:PENISSI, OSWALDO (APRN)
Entity type:Individual
Prefix:
First Name:OSWALDO
Middle Name:
Last Name:PENISSI
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18921 NW 42ND CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-2705
Mailing Address - Country:US
Mailing Address - Phone:786-498-8001
Mailing Address - Fax:
Practice Address - Street 1:210 SEBRING SQ
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1622
Practice Address - Country:US
Practice Address - Phone:863-658-5066
Practice Address - Fax:863-879-2304
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11039062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily