Provider Demographics
NPI:1073833463
Name:MORALES, NELLY A (PA)
Entity Type:Individual
Prefix:
First Name:NELLY
Middle Name:A
Last Name:MORALES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:945 W MICHIGAN AVE
Mailing Address - Street 2:SUITE 10C
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-2345
Mailing Address - Country:US
Mailing Address - Phone:850-332-6788
Mailing Address - Fax:888-660-1953
Practice Address - Street 1:945 W MICHIGAN AVE
Practice Address - Street 2:SUITE 10C
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-2345
Practice Address - Country:US
Practice Address - Phone:850-332-6788
Practice Address - Fax:888-660-1953
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2015-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC0004172363A00000X
FLPA9108689363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant