MEDICARE: DORALKIS OSORIO SIMON 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	APRN11032745	FL

General Provider Information

NPI Number	:	1942044391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORALKIS OSORIO SIMON APRN

Provider Business Mailing Address
First Line	:	14953 SW 18TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-5785
Country	:	US
Telephone Number	:	305-834-2795
Fax Number	:

Provider Business Practice Location Address
First Line	:	855 E 10TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4645
Country	:	US
Telephone Number	:	305-392-1166
Fax Number	:	888-562-3449

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

Provider Enumeration Date	:	06/20/2024
Last Update Date	:	10/02/2024

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