Provider Demographics
NPI:1124224472
Name:MORLOK-PRINCE, JESSICA ANGELA (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANGELA
Last Name:MORLOK-PRINCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33404-5708
Mailing Address - Country:US
Mailing Address - Phone:561-494-2804
Mailing Address - Fax:
Practice Address - Street 1:5955 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2423
Practice Address - Country:US
Practice Address - Phone:305-661-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 99016208000000X
FLME990162080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99016OtherME