MEDICARE: WELLNESS & RECOVERY PSYCHIATRY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1760075162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS & RECOVERY PSYCHIATRY CENTER

Provider Business Mailing Address
First Line	:	3430 NW 97TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33147-2237
Country	:	US
Telephone Number	:	786-597-7426
Fax Number	:

Provider Business Practice Location Address
First Line	:	3430 NW 97TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33147-2237
Country	:	US
Telephone Number	:	786-597-7426
Fax Number	:

Authorized Official
Title or Position	:	APRN
Name	:	MARLON MEDINA
Credential	:	PMHNP-BC
Telephone Number	:	786-597-7426

Provider Enumeration Date	:	02/16/2021
Last Update Date	:	02/16/2021

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