Healthcare Provider Details

I. General information

NPI: 1396393492
Provider Name (Legal Business Name): LORENZA METELLUS-PHILISTIN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2019
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18182 SW 27TH ST
MIRAMAR FL
33029-5188
US

IV. Provider business mailing address

18182 SW 27TH ST
MIRAMAR FL
33029-5188
US

V. Phone/Fax

Practice location:
  • Phone: 305-206-0616
  • Fax:
Mailing address:
  • Phone: 305-206-0616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11003930
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11003930
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: