Healthcare Provider Details

I. General information

NPI: 1003622341
Provider Name (Legal Business Name): KEILAN LOPEZ SERRANO REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 NW 95TH ST STE 337
HIALEAH GARDENS FL
33016-2361
US

IV. Provider business mailing address

8040 NW 95TH ST STE 337
HIALEAH GARDENS FL
33016-2361
US

V. Phone/Fax

Practice location:
  • Phone: 954-793-0775
  • Fax: 786-641-5968
Mailing address:
  • Phone: 954-793-0775
  • Fax: 786-641-5968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN9421563
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: