Provider Demographics
NPI:1487366852
Name:FANELLA, RAQUEL ROSARIO (APRN)
Entity type:Individual
Prefix:MS
First Name:RAQUEL
Middle Name:ROSARIO
Last Name:FANELLA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11030 N KENDALL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-8814
Mailing Address - Country:US
Mailing Address - Phone:305-994-1825
Mailing Address - Fax:
Practice Address - Street 1:351 N LEJEUNE RD STE 308
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5688
Practice Address - Country:US
Practice Address - Phone:305-994-1825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022987363LA2100X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine