Provider Demographics
NPI:1730972761
Name:WILLOW PSYCHIATRY AND WELLNESS
Entity type:Organization
Organization Name:WILLOW PSYCHIATRY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:CORRIA VENDRELL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:305-815-6699
Mailing Address - Street 1:3379 W 90TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-2007
Mailing Address - Country:US
Mailing Address - Phone:305-815-6699
Mailing Address - Fax:
Practice Address - Street 1:3379 W 90TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-2007
Practice Address - Country:US
Practice Address - Phone:305-815-6699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-23
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1720886401OtherNPPES