Healthcare Provider Details

I. General information

NPI: 1003567496
Provider Name (Legal Business Name): NATASHA MOREAU-JUSMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

10306 SW 19TH ST
MIRAMAR FL
33025-1796
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-7100
  • Fax:
Mailing address:
  • Phone: 786-285-8242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9312914
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN9312914
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: