Healthcare Provider Details

I. General information

NPI: 1902516925
Provider Name (Legal Business Name): MIRTHA GARCIA COLUMBIE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 NE 162ND ST
NORTH MIAMI BEACH FL
33162-4620
US

IV. Provider business mailing address

1431 NE 162ND ST
NORTH MIAMI BEACH FL
33162-4620
US

V. Phone/Fax

Practice location:
  • Phone: 305-949-0999
  • Fax:
Mailing address:
  • Phone: 305-949-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11021817
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: