Active NPI
Mitdael Moreno, APRN
- Family Nurse Practitioner
- Miami, FL
National Provider Identifier
1013432798
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- APRN9292469
- Practice address
- 12320 Quail Roost Dr
Miami, FL 33177-4930 - Phone
- (786) 237-3070
- Fax
- (786) 430-8198
- NPI assigned
- Aug 3, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | APRN9292469 | FL | Primary |
Addresses
Primary practice location
12320 Quail Roost Dr
Miami, FL 33177-4930
Mailing address
6100 Blue Lagoon Dr Ste 365
Miami, FL 33126-7010
Phone (786) 322-7333
Other practice location 1
743 NE 167th St
North Miami Beach, FL 33162-2404
Phone (307) 957-0017
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101989700 | Medicaid | FL |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mitdael.moreno@cmg.eclinicaldirectplus.com | Other |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611187200000",
"number": "1013432798",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6100 BLUE LAGOON DR STE 365",
"city": "MIAMI",
"state": "FL",
"postal_code": "331267010",
"telephone_number": "786-322-7333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12320 QUAIL ROOST DR",
"city": "MIAMI",
"state": "FL",
"postal_code": "331774930",
"telephone_number": "786-237-3070",
"fax_number": "786-430-8198"
}
],
"practiceLocations": [
{
"address_1": "743 NE 167th St",
"address_purpose": "LOCATION",
"city": "North Miami Beach",
"state": "FL",
"postal_code": "331622404",
"country_code": "US",
"telephone_number": "307-957-0017",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MORENO",
"first_name": "MITDAEL",
"name_prefix": "Mr.",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-08-03",
"last_updated": "2021-01-21",
"certification_date": "2021-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "FL",
"license": "APRN9292469",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "101989700",
"state": "FL"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mitdael.moreno@cmg.eclinicaldirectplus.com",
"affiliation": "N",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "health information has changed",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "other",
"address_1": "12320 Quail Roost Dr",
"city": "Miami",
"state": "FL",
"country_code": "US",
"postal_code": "331774930",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Miami, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.