Healthcare Provider Details

I. General information

NPI: 1649187584
Provider Name (Legal Business Name): PROSPER PATH HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3758 SW 30TH AVE
FORT LAUDERDALE FL
33312-6708
US

IV. Provider business mailing address

4000 HOLLYWOOD BLVD STE 555S
HOLLYWOOD FL
33021-6853
US

V. Phone/Fax

Practice location:
  • Phone: 305-389-8216
  • Fax:
Mailing address:
  • Phone: 305-389-8216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. KYLEE GONZALEZ
Title or Position: PRESIDENT
Credential:
Phone: 305-389-8216