Healthcare Provider Details

I. General information

NPI: 1538070008
Provider Name (Legal Business Name): MONICA JORGE BRAVO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 SW 8TH ST
MIAMI FL
33199-2516
US

IV. Provider business mailing address

810 SW 11TH WAY
HOMESTEAD FL
33034-5565
US

V. Phone/Fax

Practice location:
  • Phone: 305-348-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11050941
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: