Healthcare Provider Details

I. General information

NPI: 1861088080
Provider Name (Legal Business Name): LAZARO MOREU JR. MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2020
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

IV. Provider business mailing address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-1960
  • Fax: 305-243-1538
Mailing address:
  • Phone: 305-243-1960
  • Fax: 305-243-1538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11010369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: