Provider Demographics
NPI:1245540376
Name:COWLEY, ROBERTO (ARNP)
Entity type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:COWLEY
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10835 SW 112TH AVE APT 116
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-3230
Mailing Address - Country:US
Mailing Address - Phone:305-546-3392
Mailing Address - Fax:305-273-4648
Practice Address - Street 1:1470 NW 107TH AVE
Practice Address - Street 2:SUITE F
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2744
Practice Address - Country:US
Practice Address - Phone:786-515-7800
Practice Address - Fax:305-594-0088
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9264572363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003260200Medicaid