Individual provider Active NPI

Yusleydis Ibanez

  • Registered Nurse
  • Pembroke Pines, FL
National Provider Identifier
1609334291
Registry record updated Jan 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
RN9436668 Issued in FL
Practice address
880 SW 145TH Ave Ste 202
Pembroke Pines, FL 33027-6171
Phone
(866) 849-0692
NPI assigned
Mar 4, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11032831 FL
Registered Nurse 163W00000X RN9436668 FL Primary
Registered Nurse 163W00000X RN-112141 HI
Registered Nurse 163W00000X 10008050 OR
Registered Nurse 163W00000X 858381 NY
Registered Nurse 163W00000X RN771611 PA

Addresses

Primary practice location

880 SW 145TH Ave Ste 202
Pembroke Pines, FL 33027-6171

Mailing address

PO Box 211699
Eagan, MN 55121-3699
Phone (866) 849-0692

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250903004372 FL Practitioner - Nurse Practitioner 2365944956

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

701 N Federal Hwy
Suite 601
Hallandale Beach, FL 33009-2467

7100 Pines Blvd
Suite 22
Pembroke Pines, FL 33024-7394

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN9436668FLMDRegistered Nurse
RN-112141HIMDRegistered Nurse
858381NYMDRegistered Nurse
10008050ORMDRegistered Nurse
RN771611PAMDRegistered Nurse
11032831FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Devoted Medical Group Professional Corporation CurrentSince Aug 25, 2024 Accepting new patients
Ray of Light Home Services Inc. Current Accepting new patients

Locations

880 SW 145th Ave
Ste 202
Pembroke Pines, FL 33027
Phone (615) 275-6612

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1551657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738022400000",
    "number": "1609334291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 211699",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551213699",
            "telephone_number": "866-849-0692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 SW 145TH AVE STE 202",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330276171",
            "telephone_number": "866-849-0692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBANEZ",
        "first_name": "YUSLEYDIS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-04",
        "last_updated": "2025-01-28",
        "certification_date": "2025-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11032831",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "RN9436668",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "HI",
            "license": "RN-112141",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OR",
            "license": "10008050",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "858381",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "RN771611",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

Verify at the official NPI Registry.