=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003790601
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOVA INTEGRATIVE CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2025
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13306 SW 128TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-5899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-424-9060
-----------------------------------------------------
Fax | 53-634-4123
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13306 SW 128TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-5899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-424-9060
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MADELEISY MOLERIO
-----------------------------------------------------
Credential | CO-OWNER
-----------------------------------------------------
Telephone | 305-424-9060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------