Healthcare Provider Details

I. General information

NPI: 1689428526
Provider Name (Legal Business Name): LUZ REINA LEDESMA APRN,PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BRICKELL AVE STE 715
MIAMI FL
33131-3047
US

IV. Provider business mailing address

PO BOX 961237
MIAMI FL
33296-1237
US

V. Phone/Fax

Practice location:
  • Phone: 786-707-7135
  • Fax: 330-355-5013
Mailing address:
  • Phone: 305-763-0148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11032278
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: