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General NPI Number Information
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NPI Number | 1124458963
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Entity Type | Individual
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Provider Name | MIRATUS LOUIS MOLINE ARNP
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Gender | Male
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Dates
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Enumeration Date | 11/14/2013
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Last Update Date | 11/14/2013
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Provider Practice Location Address
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Address Line | 5258 LINTON BLVD # G1
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City | DELRAY BEACH
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State | FL
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Zip | 33484-6540
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Country | US
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Telephone | 561-330-4695
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Fax | 561-330-4696
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Provider Business Mailing Address
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Address Line | 6326 HARBOUR OAK DR
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City | LAKE WORTH
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State | FL
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Zip | 33467-6840
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Country | US
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Telephone | 239-641-2050
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Fax | 561-330-4696
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | ARNP9251699
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License Number State | FL
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