Healthcare Provider Details

I. General information

NPI: 1932371150
Provider Name (Legal Business Name): MARIE T. MOREAU APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 NW 14TH ST
MIAMI FL
33125-1609
US

IV. Provider business mailing address

8175 NW 12TH ST SUITE 306
DORAL FL
33126-1828
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-3800
  • Fax: 305-470-5846
Mailing address:
  • Phone: 786-845-0164
  • Fax: 305-470-5846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9230558
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11003660
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: