Mackenzie Aileen Miranda Padilla
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Tavares, FL
NPI 1740153196 · NPPES record last updated Mar 10, 2026
Key facts
- NPI
- 1740153196
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 11041035 (FL)
- Practice address
- 1799 Salk Ave
Tavares, FL 32778-4311 - Phone
- (352) 742-8300
- NPI assigned
- Sep 23, 2025
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Advanced Behavioral Health Center PA
Practice addresses (Care Compare)
1799 Salk Ave
Tavares, FL 32778-4311
Phone (352) 742-8300
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251208001162 | FL | Practitioner - Nurse Practitioner | 7416440466 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11041035 | FL | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Behavioral Health Center PA | Current |
Accepting new patients |
Locations
1799 Salk Ave
Tavares, FL 32778
Phone (352) 742-0445
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 11041035 | FL | Yes |
Addresses
Primary practice location
1799 Salk Ave
Tavares, FL 32778-4311
Mailing address
1799 Salk Ave
Tavares, FL 32778-4311
Other providers in Tavares, FL
- Somia Mian
- Michael M. Morgan, D.M.D, PA
- Eric Miller
- Theresa Ann Mills
- Lakeshia Milsap
- Michael L Mishkin
- Joseph Samuel Moak III
- Abdul Sattar Shariq Mohammed
- Sameh Nazeeh Adly Mohareb
- Diana N Moldoveanu
All providers in Tavares, FL · Psychiatric/Mental Health Nurse Practitioner in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.