MEDICARE: ROXANA ELAINE ROSALES PINO 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	363LF0000X	Family Nurse Practitioner	APRN11024412	FL

General Provider Information

NPI Number	:	1629775986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXANA ELAINE ROSALES PINO APRN

Provider Business Mailing Address
First Line	:	4578 W 12TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3325
Country	:	US
Telephone Number	:	305-828-1989
Fax Number	:	786-791-1253

Provider Business Practice Location Address
First Line	:	4578 W 12TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3325
Country	:	US
Telephone Number	:	305-828-1989
Fax Number	:	786-791-1253

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

Provider Enumeration Date	:	02/07/2023
Last Update Date	:	03/05/2026

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