Healthcare Provider Details

I. General information

NPI: 1902158165
Provider Name (Legal Business Name): ROGELIO DEJESUS MURO ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 DOUGLAS AVE
ALTAMONTE SPRINGS FL
32714-2509
US

IV. Provider business mailing address

121 S ORANGE AVE STE 940
ORLANDO FL
32801-3234
US

V. Phone/Fax

Practice location:
  • Phone: 407-274-9777
  • Fax: 407-637-5114
Mailing address:
  • Phone: 407-658-9687
  • Fax: 407-658-9688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberA1012021
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: