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General NPI Number Information
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NPI Number | 1477420149
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Entity Type | Organization
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Legal Business Name | NORTHLIGHT HEALTH
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Dates
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Enumeration Date | 10/18/2025
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Last Update Date | 10/18/2025
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Provider Practice Location Address
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Address Line | 19542 NW 55TH CIRCLE PL
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City | MIAMI GARDENS
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State | FL
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Zip | 33055-1624
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Country | US
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Telephone | 386-251-7028
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Fax |
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Provider Business Mailing Address
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Address Line | 7901 4TH ST N # 8904
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4305
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL PROVIDER
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Name | SUSANA LAU
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Credential | FNP
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Telephone | 386-251-7028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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