Healthcare Provider Details

I. General information

NPI: 1023824059
Provider Name (Legal Business Name): ANNISSA IRENE BELFORT PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14645 NW 77TH AVE STE 101
MIAMI LAKES FL
33014-2569
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 833-769-3524
  • Fax: 786-206-5877
Mailing address:
  • Phone: 833-769-3524
  • Fax: 786-206-5877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11036622
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: