Provider Demographics
NPI:1689260549
Name:BRUCETA FERRER, MELANIO EMILIO (ARNP)
Entity type:Individual
Prefix:
First Name:MELANIO
Middle Name:EMILIO
Last Name:BRUCETA FERRER
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5731 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2756
Mailing Address - Country:US
Mailing Address - Phone:305-409-9192
Mailing Address - Fax:
Practice Address - Street 1:8080 PASADENA BLVD STE A
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3537
Practice Address - Country:US
Practice Address - Phone:954-437-9070
Practice Address - Fax:954-437-8193
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010530363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health