Basic Information
Provider Information
NPI: 1316559016
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FERRIN
FirstName: NEYLIZ
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 16444 SW 84TH ST
Address2:  
City: MIAMI
State: FL
PostalCode: 331935735
CountryCode: US
TelephoneNumber: 7863197365
FaxNumber:  
Practice Location
Address1: 12515 SW 88TH ST
Address2:  
City: MIAMI
State: FL
PostalCode: 331861829
CountryCode: US
TelephoneNumber: 3056425366
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/24/2020
LastUpdateDate: 08/24/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/23/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X11008808FLY193400000X SINGLE SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


Home