MEDICARE: EZECHIEL MADESTIN DNP, APRN, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11021815	FL

General Provider Information

NPI Number	:	1710608344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EZECHIEL MADESTIN DNP, APRN, PMHNP-BC

Provider Business Mailing Address
First Line	:	9465 WORSWICK CT
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6423
Country	:	US
Telephone Number	:	561-797-0724
Fax Number	:	833-502-4172

Provider Business Practice Location Address
First Line	:	5813 S CONGRESS AVE
Second Line	:
City	:	ATLANTIS
State	:	FL
Zip	:	33462-1347
Country	:	US
Telephone Number	:	561-797-0724
Fax Number	:	833-502-4172

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	02/20/2026

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