Healthcare Provider Details

I. General information

NPI: 1316427313
Provider Name (Legal Business Name): JOSUE ALBERTO MORAN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2018
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8852 SW 25TH ST
MIAMI FL
33165-2019
US

IV. Provider business mailing address

8852 SW 25TH ST
MIAMI FL
33165-2019
US

V. Phone/Fax

Practice location:
  • Phone: 786-897-1748
  • Fax: 786-524-3165
Mailing address:
  • Phone: 786-897-1748
  • Fax: 786-524-3165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberAPRN9335595
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN9335595
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: