Healthcare Provider Details

I. General information

NPI: 1033438528
Provider Name (Legal Business Name): IRALDO FROMETA MOLINA APRN FNP AUTONOMOUS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 SW 107TH AVE APT 144W
MIAMI FL
33173-4376
US

IV. Provider business mailing address

8724 SW 72ND ST # 455
MIAMI FL
33173-3512
US

V. Phone/Fax

Practice location:
  • Phone: 786-873-1306
  • Fax:
Mailing address:
  • Phone: 786-873-1306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11029566
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11029566
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9420544
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: