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 1:7649 W COLONIAL DR STE 115
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-7423
Mailing Address - Country:US
Mailing Address - Phone:407-522-2080
Mailing Address - Fax:833-963-0115
Practice Address - Street 1:7649 W COLONIAL DR STE 115
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-7423
Practice Address - Country:US
Practice Address - Phone:407-522-2080
Practice Address - Fax:833-963-0115
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2023-03-07
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