=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164397030
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NILI SIEGEL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2025
-----------------------------------------------------
Last Update Date | 03/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21097 NE 27TH CT STE 490
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-1235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-705-5660
-----------------------------------------------------
Fax | 305-707-5660
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21097 NE 27TH CT STE 490
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-1235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-705-5660
-----------------------------------------------------
Fax | 305-707-5660
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 11038276
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------