Provider Demographics
NPI:1124458963
Name:MOLINE, MIRATUS LOUIS (ARNP)
Entity type:Individual
Prefix:MR
First Name:MIRATUS
Middle Name:LOUIS
Last Name:MOLINE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6326 HARBOUR OAK DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-6840
Mailing Address - Country:US
Mailing Address - Phone:239-641-2050
Mailing Address - Fax:561-330-4696
Practice Address - Street 1:5258 LINTON BLVD # G1
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6540
Practice Address - Country:US
Practice Address - Phone:561-330-4695
Practice Address - Fax:561-330-4696
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9251699363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9251699OtherFLORIDA BOARD OF NURSING