MEDICARE: JOSUE ALBERTO MORAN APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WW0000X	Wound Care Registered Nurse	APRN9335595	FL
2	363LG0600X	Gerontology Nurse Practitioner	APRN9335595	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316427313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSUE ALBERTO MORAN APRN

Provider Business Mailing Address
First Line	:	8852 SW 25TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-2019
Country	:	US
Telephone Number	:	786-897-1748
Fax Number	:	786-524-3165

Provider Business Practice Location Address
First Line	:	8852 SW 25TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-2019
Country	:	US
Telephone Number	:	786-897-1748
Fax Number	:	786-524-3165

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2018
Last Update Date	:	02/21/2023

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