Provider Demographics
NPI:1811302904
Name:TABRAUE, JOSE CAMILO (APRN)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:CAMILO
Last Name:TABRAUE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8015 NW 104TH AVE APT 26
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4484
Mailing Address - Country:US
Mailing Address - Phone:786-230-0539
Mailing Address - Fax:
Practice Address - Street 1:8015 NW 104TH AVE APT 26
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4484
Practice Address - Country:US
Practice Address - Phone:786-230-0539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FL11011046363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No101Y00000XBehavioral Health & Social Service ProvidersCounselor