Basic Information
| Provider Information | |||||||||
| NPI: | 1942317227 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUBUISSON | ||||||||
| FirstName: | MYRLANDE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4100 SW 143RD AVE | ||||||||
| Address2: | |||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330273049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544312140 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16161 NW 57TH AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330146707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056253409 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 1812982 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 305721600 | 05 | FL | MEDICAID |