Healthcare Provider Details

I. General information

NPI: 1891652111
Provider Name (Legal Business Name): ANTHONY OMAR BUERGO APRN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 NW 10TH AVE
MIAMI FL
33136-1018
US

IV. Provider business mailing address

1800 NW 10TH AVE
MIAMI FL
33136-1018
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-1152
  • Fax:
Mailing address:
  • Phone: 305-585-1152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberAPRN11044742
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: