Provider Demographics
NPI:1861981367
Name:SERPA, NURYS
Entity type:Individual
Prefix:MS
First Name:NURYS
Middle Name:
Last Name:SERPA
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 1:9010 SW 59TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1611
Mailing Address - Country:US
Mailing Address - Phone:786-247-1946
Mailing Address - Fax:305-819-1104
Practice Address - Street 1:7100 W 20TH AVE STE 506
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1824
Practice Address - Country:US
Practice Address - Phone:305-819-1104
Practice Address - Fax:305-819-1107
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9457186363LF0000X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily