Provider Demographics
NPI:1285040907
Name:CARDOSO, ROBERTO (MSN, APRN, FPN-C)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:CARDOSO
Suffix:
Gender:M
Credentials:MSN, APRN, FPN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15105 NW 77TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-7803
Mailing Address - Country:US
Mailing Address - Phone:305-455-2737
Mailing Address - Fax:
Practice Address - Street 1:15105 NW 77TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-7803
Practice Address - Country:US
Practice Address - Phone:305-455-2737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005012363LP2300X, 363LF0000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No104100000XBehavioral Health & Social Service ProvidersSocial Worker