Healthcare Provider Details

I. General information

NPI: 1457132276
Provider Name (Legal Business Name): ROXANA MORALES TIRADO APRN- FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 SW 88TH ST STE 175
MIAMI FL
33186-1528
US

IV. Provider business mailing address

14801 SW 77TH ST
MIAMI FL
33193-1120
US

V. Phone/Fax

Practice location:
  • Phone: 305-387-0081
  • Fax:
Mailing address:
  • Phone: 786-454-6579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11026410
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: