Healthcare Provider Details

I. General information

NPI: 1144896754
Provider Name (Legal Business Name): CLAIRE MARIE MASFORROLL DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 06/03/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1611 NW 12TH AVE HOLTZ EAST TOWER 6B
MIAMI FL
33136
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberAPRN11010063
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: