Active NPI
Moreno Tulloch
- Adult Health Nurse Practitioner
- Fort Lauderdale, FL
National Provider Identifier
1992083315
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 2038692
- Practice address
- 5420 N.W. 33Rd Avenue
Fort Lauderdale, FL 33309-2850 - Phone
- (954) 777-1330
- NPI assigned
- Aug 2, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 2038692 | FL | Primary |
Addresses
Primary practice location
5420 N.W. 33Rd Avenue
Fort Lauderdale, FL 33309-2850
Mailing address
5420 NW 33Rd Ave
Fort Lauderdale, FL 33309-6348
Phone (954) 777-1421
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161209001419 | FL | Order and Referring Only - Nurse Practitioner | 3274813100 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2038692 | FL | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476057600000",
"number": "1992083315",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5420 NW 33RD AVE",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333096348",
"telephone_number": "954-777-1421"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5420 N.W. 33RD AVENUE",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333092850",
"telephone_number": "954-777-1330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TULLOCH",
"first_name": "MORENO",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-02",
"last_updated": "2016-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "FL",
"license": "2038692",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Lauderdale, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.