Healthcare Provider Details

I. General information

NPI: 1942023676
Provider Name (Legal Business Name): HEALTH KTP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12955 BISCAYNE BLVD STE 200
NORTH MIAMI FL
33181-2021
US

IV. Provider business mailing address

12955 BISCAYNE BLVD STE 200
NORTH MIAMI FL
33181-2021
US

V. Phone/Fax

Practice location:
  • Phone: 786-245-3035
  • Fax:
Mailing address:
  • Phone: 786-245-3035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIRA TEJADA
Title or Position: NURSE PRACTITIONER
Credential: APRN
Phone: 786-245-3035