=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235768565
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAILEN LORENZO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2020
-----------------------------------------------------
Last Update Date | 03/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8940 N KENDALL DR STE 802E
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-2151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-595-4041
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9960 NW 116TH WAY STE 13
-----------------------------------------------------
City | MEDLEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33178-1175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-924-1311
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 11006583
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------