Healthcare Provider Details

I. General information

NPI: 1437025640
Provider Name (Legal Business Name): HILDA MAHMOUDI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

IV. Provider business mailing address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-5302
  • Fax: 305-243-9161
Mailing address:
  • Phone: 305-243-5302
  • Fax: 305-243-9161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11042811
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: