Provider Demographics
NPI:1225893589
Name:MOYANO, MARCELO JAVIER (APRN)
Entity Type:Individual
Prefix:
First Name:MARCELO
Middle Name:JAVIER
Last Name:MOYANO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N BAYSHORE DR APT 2903
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-3015
Mailing Address - Country:US
Mailing Address - Phone:305-394-5232
Mailing Address - Fax:
Practice Address - Street 1:1900 N BAYSHORE DR
Practice Address - Street 2:2903
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-3015
Practice Address - Country:US
Practice Address - Phone:305-394-5232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11030502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty