Provider Demographics
NPI:1598552143
Name:MINDTRA LLC
Entity type:Organization
Organization Name:MINDTRA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:SMHNP
Authorized Official - Phone:786-246-6150
Mailing Address - Street 1:44 NW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-3211
Mailing Address - Country:US
Mailing Address - Phone:305-209-4750
Mailing Address - Fax:305-824-8803
Practice Address - Street 1:44 NW 17TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-3211
Practice Address - Country:US
Practice Address - Phone:305-209-4750
Practice Address - Fax:305-824-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty