Healthcare Provider Details

I. General information

NPI: 1013724962
Provider Name (Legal Business Name): REBECCA MARIE HIDALGO APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5420 W 26TH AVE
HIALEAH FL
33016-4030
US

IV. Provider business mailing address

7120 BAMBOO ST
MIAMI LAKES FL
33014-2947
US

V. Phone/Fax

Practice location:
  • Phone: 786-556-7688
  • Fax:
Mailing address:
  • Phone: 786-556-7688
  • Fax: 786-404-1072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11036802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: