Healthcare Provider Details

I. General information

NPI: 1316876550
Provider Name (Legal Business Name): MAIKEL A BRUCETA VELAZQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 NW 40TH AVE
COCONUT CREEK FL
33066-2033
US

IV. Provider business mailing address

2900 W CYPRESS CREEK RD STE 5AND
FORT LAUDERDALE FL
33309-1715
US

V. Phone/Fax

Practice location:
  • Phone: 305-409-5698
  • Fax:
Mailing address:
  • Phone: 305-409-5698
  • Fax: 954-432-8832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11047599
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: