Healthcare Provider Details

I. General information

NPI: 1942044037
Provider Name (Legal Business Name): KYLE JORDAN AVEIGA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 SW 74TH CT STE 1808
MIAMI FL
33156-3177
US

IV. Provider business mailing address

2672 W 72ND ST
HIALEAH FL
33016-5419
US

V. Phone/Fax

Practice location:
  • Phone: 305-300-3121
  • Fax:
Mailing address:
  • Phone: 305-338-8163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11033066
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11033066
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11033066
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: