Radouane Laktib, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN11031382 Issued in FL

Practice address

4202 E Fowler Ave
Tampa, FL 33620-8000

Phone

(813) 974-2331

NPI assigned

Feb 21, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL, ID, NY3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  ID, NY, Psychiatric/Mental Health

  Medicare reassignment NPD
• University Medical Service Association Inc

  • Physical Therapist
  • Tampa, FL
  • NPI 1992742324
  Medicare reassignment NPD
• Tampa General Hospital

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1124558929
  NPD
• University Medical Service Association Inc

  • Durable Medical Equipment & Medical Supplies
  • Tampa, FL
  • NPI 1194276576
  NPD
• University Medical Service Association Inc

  • General Practice Physician
  • Tampa, FL
  • NPI 1326088295
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1708473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713916800000",
    "number": "1255196945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10411 GOLDENBROOK WAY",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336473169",
            "telephone_number": "813-857-1181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4202 E FOWLER AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336208000",
            "telephone_number": "813-974-2331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKTIB",
        "first_name": "RADOUANE",
        "name_prefix": "Mr.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-21",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN11031382",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121788700",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "ERQTY",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rlaktib293578@direct.tgh.org",
            "affiliation": "N",
            "address_1": "4202 E Fowler Ave",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336208000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lakeside Occupational Medical Centers, Inc.
• Lakeside Occupational Medical Centers, Inc.
• Lakeside Occupational Medical Centers, Inc.
• Anas Lakhani
• Seetha Lakshmi, M.D
• Christine Lalime
• Peter M Lally, LCSW
• Lalone Counseling LLC
• Cesar Lam
• Clarissa Joyce Lam, MD

• Psychiatric/Mental Health Nurse Practitioner in Tampa, FL
• Providers in Tampa, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.