Provider Demographics
NPI:1528285830
Name:NAHRSTEDT, TOM
Entity type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:NAHRSTEDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 S DIXIE HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2456
Mailing Address - Country:US
Mailing Address - Phone:305-285-8900
Mailing Address - Fax:305-285-1462
Practice Address - Street 1:2000 S DIXIE HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2456
Practice Address - Country:US
Practice Address - Phone:305-285-8900
Practice Address - Fax:305-285-1462
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLPCC72990101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL592607252OtherTAX ID