Provider Demographics
NPI:1063891893
Name:BERRIO OROZCO, MAURICIO (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MAURICIO
Middle Name:
Last Name:BERRIO OROZCO
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:16313 NEW INDEPENDENCE PKWY # 110
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-8113
Practice Address - Country:US
Practice Address - Phone:407-593-4665
Practice Address - Fax:407-656-4591
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306583363LA2200X
FL11005730363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQC331OtherMEDICARE PTAN
FL112917700Medicaid
FLAPRN11005730OtherSTATE MEDICAL LICENSE
FLAPRN11005730OtherSTATE MEDICAL LICENSE