Healthcare Provider Details

I. General information

NPI: 1114861887
Provider Name (Legal Business Name): KATIA L DORVILUS MSN , APRN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 NW 177TH TER
MIAMI GARDENS FL
33056-3617
US

IV. Provider business mailing address

2240 NW 177TH TER
MIAMI GARDENS FL
33056-3617
US

V. Phone/Fax

Practice location:
  • Phone: 954-309-6910
  • Fax:
Mailing address:
  • Phone: 954-309-6910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number70113856
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408385
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: