Provider Demographics
NPI:1730790544
Name:MORENO RODRIGUEZ, ESTRELLA M (APRN)
Entity type:Individual
Prefix:
First Name:ESTRELLA
Middle Name:M
Last Name:MORENO RODRIGUEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15753 SW 100TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-6117
Mailing Address - Country:US
Mailing Address - Phone:786-317-1236
Mailing Address - Fax:
Practice Address - Street 1:15753 SW 100TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-6117
Practice Address - Country:US
Practice Address - Phone:786-317-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily