Healthcare Provider Details

I. General information

NPI: 1285040907
Provider Name (Legal Business Name): ROBERTO CARDOSO MSN, APRN, FPN-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 02/10/2024
Certification Date: 02/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15105 NW 77TH AVE
MIAMI LAKES FL
33014-7803
US

IV. Provider business mailing address

15105 NW 77TH AVE
MIAMI LAKES FL
33014-7803
US

V. Phone/Fax

Practice location:
  • Phone: 305-455-2737
  • Fax:
Mailing address:
  • Phone: 305-455-2737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11005012
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11005012
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: