Provider Demographics
NPI:1750105334
Name:ZELENA NP LLC
Entity type:Organization
Organization Name:ZELENA NP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZOILA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTA VERGARA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP-PMHNP-BC
Authorized Official - Phone:754-244-4322
Mailing Address - Street 1:9765 NW 45TH LN
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-3367
Mailing Address - Country:US
Mailing Address - Phone:754-244-4322
Mailing Address - Fax:
Practice Address - Street 1:3105 NW 107TH AVE STE 400-H11
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2185
Practice Address - Country:US
Practice Address - Phone:305-514-9045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty