Healthcare Provider Details

I. General information

NPI: 1083501571
Provider Name (Legal Business Name): TYLER ROBERT NIEVES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BRICKELL AVE
MIAMI FL
33131-3009
US

IV. Provider business mailing address

1000 BRICKELL AVE STE 715
MIAMI FL
33131-3047
US

V. Phone/Fax

Practice location:
  • Phone: 786-983-5399
  • Fax: 786-698-1906
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95036313
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11044449
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95115411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: