Provider Demographics
NPI:1023500204
Name:MORAN, HENRY (ARNP)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:MORAN
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 1:4711 SW 143RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6894
Mailing Address - Country:US
Mailing Address - Phone:305-345-2080
Mailing Address - Fax:305-200-0161
Practice Address - Street 1:4711 SW 143RD CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6894
Practice Address - Country:US
Practice Address - Phone:305-345-2080
Practice Address - Fax:305-200-0161
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9277744363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner