MEDICARE: JOSE NICOLAS TOBOSO

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	363LF0000X	Family Nurse Practitioner	ARNP11008516	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	:	1467067330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE NICOLAS TOBOSO

Provider Business Mailing Address
First Line	:	6100 BLUE LAGOON DR STE 365
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-7010
Country	:	US
Telephone Number	:	786-322-7333
Fax Number	:	786-347-5022

Provider Business Practice Location Address
First Line	:	3805 W 20TH AVE STE 105
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4532
Country	:	US
Telephone Number	:	305-557-2277
Fax Number	:	786-621-7818

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

Provider Enumeration Date	:	09/09/2020
Last Update Date	:	07/01/2021

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Directions to “ JOSE NICOLAS TOBOSO ” Practice Location

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