MEDICARE: AMARILYS ROQUE ROQUE BAZ

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	APRN11013393	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	:	1215503305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMARILYS ROQUE ROQUE BAZ

Provider Business Mailing Address
First Line	:	8507 DAWN DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-7923
Country	:	US
Telephone Number	:	407-556-5726
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 S ORANGE AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-3221
Country	:	US
Telephone Number	:	407-556-5726
Fax Number	:

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

Provider Enumeration Date	:	05/31/2021
Last Update Date	:	05/31/2021

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