Provider Demographics
NPI:1093366205
Name:MORALES, MILAGROS J
Entity Type:Individual
Prefix:
First Name:MILAGROS
Middle Name:J
Last Name:MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 OAKLEAF PLANTATION PARKWAY
Mailing Address - Street 2:UNIT 815
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065
Mailing Address - Country:US
Mailing Address - Phone:787-340-1306
Mailing Address - Fax:
Practice Address - Street 1:625 OAKLEAF PLANTATION PARKWAY
Practice Address - Street 2:UNIT 815
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065
Practice Address - Country:US
Practice Address - Phone:787-340-1306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-28
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF09191864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily