MI DYNAMIC MEDICAL GROUP LLC NPI 1700777224

NPI Information

  • NPI: 1700777224
  • Provider Name: MI DYNAMIC MEDICAL GROUP LLC
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Organization
  • Address: 1222 SE 47TH ST STE 201
    CAPE CORAL, FL
    ZIP 33904
  • Phone: (239) 342-6516

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NPI Details

MI DYNAMIC MEDICAL GROUP LLC is a psychiatric/mental health nurse practitioner in Cape Coral, FL. MI DYNAMIC MEDICAL GROUP LLC NPI is 1700777224. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1222 SE 47TH ST STE 201
CAPE CORAL, FL
ZIP 33904-602
Phone: (239) 342-6516
Fax: (239) 374-8342

The provider's authorized official is Ivette Dieguez .
The authorized official title is Aprn and has the following contact phone number (239) 342-6516.

The enumeration date for this NPI number is 7/12/2025 and was last updated on 9/12/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LP0808XNurse PractitionerPsychiatric/Mental HealthYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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