Provider Demographics
NPI:1548629405
Name:HEARTWELL
Entity type:Organization
Organization Name:HEARTWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PELAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-275-8200
Mailing Address - Street 1:7400 SW 87TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-5458
Mailing Address - Country:US
Mailing Address - Phone:305-275-8200
Mailing Address - Fax:305-274-7812
Practice Address - Street 1:7400 SW 87TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5458
Practice Address - Country:US
Practice Address - Phone:305-275-8200
Practice Address - Fax:305-274-7812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3065112363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty