Healthcare Provider Details

I. General information

NPI: 1043182983
Provider Name (Legal Business Name): GT HEALTH & MENTAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2025
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 FONTAINEBLEAU BLVD STE 2G11
MIAMI FL
33172-7012
US

IV. Provider business mailing address

175 FONTAINEBLEAU BLVD STE 2G11
MIAMI FL
33172-7012
US

V. Phone/Fax

Practice location:
  • Phone: 786-402-6081
  • Fax:
Mailing address:
  • Phone: 786-402-6081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JORGE TASE
Title or Position: MANAGER
Credential: APRN
Phone: 786-738-3682