Healthcare Provider Details

I. General information

NPI: 1922965722
Provider Name (Legal Business Name): GRETEL SANTANA BASULTO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176-2118
US

IV. Provider business mailing address

7910 SW 13TH TER
MIAMI FL
33144-5220
US

V. Phone/Fax

Practice location:
  • Phone: 786-488-7544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11044361
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: