Denebola TR

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

DENEBOLA TR

Practice address

2225 NE 14TH Ave
Wilton Manors, FL 33305-2305

Phone

(763) 843-4433

NPI assigned

Jul 22, 2024

Last updated

Jul 22, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Beau Van Morrison

Title

Owner

Phone

(866) 954-1583

Specialties & licenses 1

Addresses

Other names 1

• Med Ex Pro Solutions Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kyle James Oleary, ARNP

  • Nurse Practitioner
  • Wilton Manors, FL
  • NPI 1417679762

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1721606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721606400000",
    "number": "1376371450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15500 VOSS RD # 1079",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "774984601",
            "telephone_number": "866-954-1583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 NE 14TH AVE",
            "city": "WILTON MANORS",
            "state": "FL",
            "postal_code": "333052305",
            "telephone_number": "763-843-4433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENEBOLA TR",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-22",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A",
        "authorized_official_last_name": "MORRISON",
        "authorized_official_first_name": "BEAU",
        "authorized_official_middle_name": "VAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "866-954-1583"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Med Ex Pro Solutions",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Myron Gy'Ton Davidson, M.D.
• Kavitha Davis
• William J Davis, RPH
• Kelsey Deidrick, MD
• Shirley Carolina Delmoral, LMHC
• Joyce Despres
• Mark Daniel Dhooge
• Carlos S Diaz Barcelo, M.D.
• Jonathan Raymond Dolan, LMHC
• Donald John Fensterman

• Family Nurse Practitioner in Wilton Manors, FL
• Providers in Wilton Manors, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.