=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306396536
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIRSTEN LUFT AGACNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2016
-----------------------------------------------------
Last Update Date | 12/07/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1611 NW 12TH AVE INSTITUTE BLDG. 5TH FLOOR, ROOM 515A
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33136-1005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-585-7725
-----------------------------------------------------
Fax | 305-355-2432
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1611 NW 12TH AVE INSTITUTE BLDG. 5TH FLOOR, ROOM 515A
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33136-1005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-585-7725
-----------------------------------------------------
Fax | 305-355-2432
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine Nurse Practitioner
-----------------------------------------------------
License Number | 9229292
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------