MEDICARE: JOSE M MARIA FAMILY HEALTH NURSE PRACTITIONER PC

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

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	:	1386410587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE M MARIA FAMILY HEALTH NURSE PRACTITIONER PC

Provider Business Mailing Address
First Line	:	3184 GRAND CONCOURSE APT 2D
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-1031
Country	:	US
Telephone Number	:	917-518-6593
Fax Number	:

Provider Business Practice Location Address
First Line	:	3184 GRAND CONCOURSE APT 2D
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-1031
Country	:	US
Telephone Number	:	917-518-6593
Fax Number	:

Authorized Official
Title or Position	:	OWNER / PROVIDER
Name	:	JOSE M MARIA
Credential	:	NP
Telephone Number	:	917-518-6593

Provider Enumeration Date	:	11/29/2023
Last Update Date	:	11/29/2023

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