Provider Demographics
NPI:1487384640
Name:YANEZ-COSCULLUELA, LISSETTE MARIA (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:LISSETTE
Middle Name:MARIA
Last Name:YANEZ-COSCULLUELA
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15920 W PRESTWICK PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6526
Mailing Address - Country:US
Mailing Address - Phone:305-216-1867
Mailing Address - Fax:
Practice Address - Street 1:15920 W PRESTWICK PL
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6526
Practice Address - Country:US
Practice Address - Phone:305-216-1867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-12
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11019936363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily