Healthcare Provider Details

I. General information

NPI: 1366302960
Provider Name (Legal Business Name): ADVANTA HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2025
Last Update Date: 11/15/2025
Certification Date: 11/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5190 NW 167TH ST STE 105
MIAMI LAKES FL
33014-6329
US

IV. Provider business mailing address

5190 NW 167TH ST STE 105
MIAMI LAKES FL
33014-6329
US

V. Phone/Fax

Practice location:
  • Phone: 305-974-5380
  • Fax: 305-974-5580
Mailing address:
  • Phone: 305-974-5380
  • Fax: 305-974-5580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GRETEL MONTANO
Title or Position: OWNER / NURSE PRACTITIONER
Credential: APRN
Phone: 786-296-5234