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Provider Information for 1053822791

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1053822791

Calendar   Last Updated:  2017-10-20
  Certification Date: 


Name Value
NPI 1053822791
Enumeration Date 2017-10-20
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 12124 SAINT ANDREWS PL APT 303
MIRAMAR, FL 33025-0703
United States

Phone: 918-636-7230 | Fax:
View Map External Link
Primary Practice Address 3750 W 16TH AVE STE 126U
HIALEAH, FL 33012-4645
United States

Phone: 305-557-3444 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 363LP0808X - Nurse Practitioner Psych/Mental Health FL 9426070