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General NPI Number Information
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NPI Number | 1366302960
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Entity Type | Organization
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Legal Business Name | ADVANTA HEALTH LLC
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Dates
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Enumeration Date | 11/15/2025
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Last Update Date | 11/15/2025
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Provider Practice Location Address
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Address Line | 5190 NW 167TH ST STE 105
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City | MIAMI LAKES
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State | FL
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Zip | 33014-6329
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Country | US
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Telephone | 305-974-5380
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Fax | 305-974-5580
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Provider Business Mailing Address
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Address Line | 5190 NW 167TH ST STE 105
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City | MIAMI LAKES
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State | FL
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Zip | 33014-6329
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Country | US
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Telephone | 305-974-5380
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Fax | 305-974-5580
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Authorized Official
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Title or Position | OWNER / NURSE PRACTITIONER
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Name | GRETEL MONTANO
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Credential | APRN
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Telephone | 786-296-5234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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