Healthcare Provider Details

I. General information

NPI: 1447856661
Provider Name (Legal Business Name): LYNETTE DE LA CARIDAD PAULA JORGE APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LYNETTE D PAULA JORGE APRN, PMHNP-BC

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 07/07/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8323 NW 12TH ST STE 108
DORAL FL
33126-1839
US

IV. Provider business mailing address

8323 NW 12TH ST STE 108
DORAL FL
33126-1839
US

V. Phone/Fax

Practice location:
  • Phone: 305-400-8511
  • Fax: 305-392-0184
Mailing address:
  • Phone: 305-400-8511
  • Fax: 305-392-0184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11038804
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: