Provider Demographics
NPI:1932371150
Name:MOREAU, MARIE T (APRN)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:T
Last Name:MOREAU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8175 NW 12TH ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1828
Mailing Address - Country:US
Mailing Address - Phone:786-845-0164
Mailing Address - Fax:305-470-5846
Practice Address - Street 1:1350 NW 14TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1609
Practice Address - Country:US
Practice Address - Phone:305-575-3800
Practice Address - Fax:305-470-5846
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9230558163W00000X
FLAPRN11003660363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1720171895OtherFLORIDA DPT OF HEALTH-NPI