Provider Demographics
NPI:1467067330
Name:TOBOSO, JOSE NICOLAS
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:NICOLAS
Last Name:TOBOSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 BLUE LAGOON DR STE 365
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-7010
Mailing Address - Country:US
Mailing Address - Phone:786-322-7333
Mailing Address - Fax:786-347-5022
Practice Address - Street 1:3805 W 20TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4532
Practice Address - Country:US
Practice Address - Phone:305-557-2277
Practice Address - Fax:786-621-7818
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP11008516363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily