Provider Demographics
NPI:1457132276
Name:MORALES TIRADO, ROXANA (APRN- FNP)
Entity Type:Individual
Prefix:
First Name:ROXANA
Middle Name:
Last Name:MORALES TIRADO
Suffix:
Gender:F
Credentials:APRN- FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14801 SW 77TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1120
Mailing Address - Country:US
Mailing Address - Phone:786-454-6579
Mailing Address - Fax:
Practice Address - Street 1:13500 SW 88TH ST STE 175
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1528
Practice Address - Country:US
Practice Address - Phone:305-387-0081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11026410363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily