Healthcare Provider Details

I. General information

NPI: 1750105334
Provider Name (Legal Business Name): ZELENA NP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 NW 107TH AVE STE 400-H11
DORAL FL
33172-2185
US

IV. Provider business mailing address

9765 NW 45TH LN
DORAL FL
33178-3367
US

V. Phone/Fax

Practice location:
  • Phone: 305-514-9045
  • Fax:
Mailing address:
  • Phone: 754-244-4322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. ZOILA ANTA VERGARA
Title or Position: PRESIDENT
Credential: ARNP-PMHNP-BC
Phone: 754-244-4322