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General NPI Number Information
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NPI Number | 1164147393
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Entity Type | Individual
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Provider Name | JOSE MARINO-MORALES APRN
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Gender | Male
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Dates
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Enumeration Date | 10/10/2022
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 5615 S FLORIDA AVE STE 111
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City | LAKELAND
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State | FL
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Zip | 33813-2714
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Country | US
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Telephone | 863-327-0132
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Fax |
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Provider Business Mailing Address
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Address Line | 6100 BLUE LAGOON DR STE 365
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City | MIAMI
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State | FL
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Zip | 33126-7010
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Country | US
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Telephone | 786-322-7333
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11022448
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11022448
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License Number State | FL
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