Provider Demographics
NPI:1700518008
Name:AVILUS, URSULA (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:URSULA
Middle Name:
Last Name:AVILUS
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6052 SW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-4613
Mailing Address - Country:US
Mailing Address - Phone:954-203-2470
Mailing Address - Fax:
Practice Address - Street 1:5200 EAST AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2374
Practice Address - Country:US
Practice Address - Phone:954-203-2470
Practice Address - Fax:856-329-8719
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020488363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health