Individual ProviderDorisley Travieso JorgeNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address19001 SW 106th Ave, Cutler Bay, FL 33157-7669(305) 255-9806(305) 766-4845PECOS EnrollmentBased on the most recent information from CMS, provider Dorisley Travieso Jorge is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1700375052Provider TypeIndividualFull NameTravieso Jorge, DorisleyCredentialARNPGenderFemaleSole ProprietorNoEnumeration Date5/2/2018Last Updated5/1/2019Contact InformationPractice LocationPractice Address19001 SW 106th Ave, Cutler Bay, FL 33157-7669Phone(305) 255-9806Fax(305) 255-9807Mailing LocationMailing Address6423 SW 162nd Ave, Miami, FL 33193-5833Phone(305) 766-4845FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense9402632FloridaCode163WG0000XDescriptionRegistered NurseNursing Service ProvidersLicense9402632FloridaCode363L00000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseARNP9402632FloridaCode363LP2300XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseARNP9402632Florida