Healthcare Provider Details

I. General information

NPI: 1467067330
Provider Name (Legal Business Name): JOSE NICOLAS TOBOSO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 W 20TH AVE STE 105
HIALEAH FL
33012-4532
US

IV. Provider business mailing address

6100 BLUE LAGOON DR STE 365
MIAMI FL
33126-7010
US

V. Phone/Fax

Practice location:
  • Phone: 305-557-2277
  • Fax: 786-621-7818
Mailing address:
  • Phone: 786-322-7333
  • Fax: 786-347-5022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP11008516
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: