Healthcare Provider Details

I. General information

NPI: 1912464710
Provider Name (Legal Business Name): EDUARDO COLUNGA APRN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 W FLAGLER ST STE 21
MIAMI FL
33144-2069
US

IV. Provider business mailing address

1401 SW 67TH AVE APT 5
MIAMI FL
33144-5567
US

V. Phone/Fax

Practice location:
  • Phone: 786-715-9183
  • Fax:
Mailing address:
  • Phone: 786-678-8065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11000941
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11000941
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: