Healthcare Provider Details

I. General information

NPI: 1124734652
Provider Name (Legal Business Name): DANIEL MEJIA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/27/2023
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 NW 14TH ST STE 303
MIAMI FL
33125-1655
US

IV. Provider business mailing address

1321 NW 14TH ST STE 303
MIAMI FL
33125-1655
US

V. Phone/Fax

Practice location:
  • Phone: 305-689-0681
  • Fax:
Mailing address:
  • Phone: 305-689-0681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11020716
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: