Healthcare Provider Details

I. General information

NPI: 1669920237
Provider Name (Legal Business Name): MR. MIGUEL MESTRE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MIGUEL MESTRE JR. ARNP-C

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 RIDGE CENTER DR
DAVENPORT FL
33837-6413
US

IV. Provider business mailing address

47 5TH ST NW
WINTER HAVEN FL
33881-4672
US

V. Phone/Fax

Practice location:
  • Phone: 866-234-8534
  • Fax:
Mailing address:
  • Phone: 866-234-8534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9198073
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9198073
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP9198073
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN9198073
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP9198073
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: