Healthcare Provider Details

I. General information

NPI: 1003159070
Provider Name (Legal Business Name): DINAPOLES GALVAN PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

484 NW 165TH STREET RD APT 409
MIAMI FL
33169-6461
US

IV. Provider business mailing address

484 NW 165TH STREET RD APT 409
MIAMI FL
33169-6461
US

V. Phone/Fax

Practice location:
  • Phone: 312-451-3853
  • Fax: 217-771-1679
Mailing address:
  • Phone: 312-451-3853
  • Fax: 217-771-1679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209025036
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number312571
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10042956
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number209025036
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12292
License Number StateMN
# 6
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11018626
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9548024
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: