NPIMap

Individual provider Active NPI

Lillian Lastra, ARNP

  • Family Nurse Practitioner
  • Pembroke Pines, FL
National Provider Identifier
1629584065
Registry record updated Jul 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN3224032 Issued in FL
Practice address
8967 Taft St
Pembroke Pines, FL 33024-4648
Phone
(855) 226-6633
NPI assigned
Dec 21, 2017
Last updated
Jul 13, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN3224032 FL Primary
Registered Nurse 163W00000X RN3224032 FL

Addresses

Primary practice location

8967 Taft St
Pembroke Pines, FL 33024-4648

Mailing address

21097 NE 27TH CT Ste 110
Aventura, FL 33180-1206
Phone (305) 384-4720

Other practice location 1

16368 NW 18th St
Pembroke Pines, FL 33028-1734
Phone (954) 443-1897

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190222000025 FL Practitioner - Nurse Practitioner 3779822598 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
South Broward Hospital DistrictGroup PAC ID 8123927373, 659 clinicians

Practice addresses (Care Compare)

20803 Biscayne Blvd
Suite 204
Aventura, FL 33180-1429
Phone (954) 265-7900

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN3224032FLMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
South Broward Hospital District CurrentSince Jul 7, 2022 Accepting new patients
Leonard J Pianko MD PA CurrentSince Oct 9, 2018 Accepting new patients
South Broward Hospital District Current Accepting new patients
South Broward Hospital District CurrentSince Jul 7, 2022 Accepting new patients
South Broward Hospital District Past Accepting new patients

Locations

20803 Biscayne Blvd
Ste 204
Aventura, FL 33180

1150 N 35th Ave
Ste 605
Hollywood, FL 33021
Phone (954) 965-2966

21097 NE 27th Ct
Ste 110
Miami, FL 33180
Phone (305) 384-4720

2900 Corporate Way
#D
Miramar, FL 33025
Phone (954) 276-5581

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EGEJCA

Organizations & group practices 5

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

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1513814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594598400000",
    "number": "1629584065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21097 NE 27TH CT STE 110",
            "city": "AVENTURA",
            "state": "FL",
            "postal_code": "331801206",
            "telephone_number": "305-384-4720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8967 TAFT ST",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330244648",
            "telephone_number": "855-226-6633"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16368 NW 18th St",
            "address_purpose": "LOCATION",
            "city": "Pembroke Pines",
            "state": "FL",
            "postal_code": "330281734",
            "country_code": "US",
            "telephone_number": "954-443-1897",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LASTRA",
        "first_name": "LILLIAN",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-21",
        "last_updated": "2020-07-13",
        "certification_date": "2020-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN3224032",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "RN3224032",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

Verify at the official NPI Registry.