MEDICARE: ILEANA MARIA FIALLO MOREJON APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	11006584	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194337444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILEANA MARIA FIALLO MOREJON APRN

Provider Business Mailing Address
First Line	:	6100 BLUE LAGOON DR STE 365
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-7010
Country	:	US
Telephone Number	:	786-322-7333
Fax Number	:	786-347-5022

Provider Business Practice Location Address
First Line	:	751 W PALM DR
Second Line	:
City	:	FLORIDA CITY
State	:	FL
Zip	:	33034-3223
Country	:	US
Telephone Number	:	786-377-0120
Fax Number	:	305-248-6106

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2020
Last Update Date	:	07/21/2022

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