Individual provider Active NPI

Lissett Morales Roque, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Hialeah, FL
National Provider Identifier
1457206963
Registry record updated Mar 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
11045662 Issued in FL
Practice address
PO Box 126900
Hialeah, FL 33012-1614
Phone
(786) 603-6109
NPI assigned
Mar 2, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 11045662 FL Primary

Addresses

Primary practice location

PO Box 126900
Hialeah, FL 33012-1614

Mailing address

PO Box 126900
Hialeah, FL 33012-1614
Phone (786) 603-6109

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260602003042 FL Practitioner - Nurse Practitioner 4789155664 Practice locations: Miramar, FL

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Miramar, FL 33025
Phone (786) 603-6109

2494 Centergate Dr
Apt 107
Miramar, FL 33025-7220

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11045662FLMDPsychiatric/Mental Health Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1772409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772409600000",
    "number": "1457206963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 126900",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330121614",
            "telephone_number": "786-603-6109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 126900",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330121614",
            "telephone_number": "786-603-6109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORALES ROQUE",
        "first_name": "LISSETT",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-03-02",
        "last_updated": "2026-03-02",
        "certification_date": "2026-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "11045662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hialeah, FL

Sources for this page

Verify at the official NPI Registry.