Provider Demographics
NPI:1114477924
Name:MORENO HERRERA, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:MORENO HERRERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:MORENO HERRERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:24724 SW 110TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-4402
Mailing Address - Country:US
Mailing Address - Phone:786-853-9531
Mailing Address - Fax:
Practice Address - Street 1:8380 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144
Practice Address - Country:US
Practice Address - Phone:786-536-2558
Practice Address - Fax:786-536-2829
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9360319261Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center