Healthcare Provider Details

I. General information

NPI: 1588596415
Provider Name (Legal Business Name): ADRIAN MOREDO APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 SW 102ND CT
MIAMI FL
33165-4961
US

IV. Provider business mailing address

4012 SW 102ND CT
MIAMI FL
33165-4961
US

V. Phone/Fax

Practice location:
  • Phone: 786-832-2741
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN11047990
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: