Provider Demographics
NPI:1902158165
Name:MURO, ROGELIO DEJESUS (ARNP)
Entity Type:Individual
Prefix:
First Name:ROGELIO
Middle Name:DEJESUS
Last Name:MURO
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S ORANGE AVE STE 940
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3234
Mailing Address - Country:US
Mailing Address - Phone:407-658-9687
Mailing Address - Fax:407-658-9688
Practice Address - Street 1:659 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2509
Practice Address - Country:US
Practice Address - Phone:407-274-9777
Practice Address - Fax:407-637-5114
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLA1012021363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9307937OtherLICENSE