Provider Demographics
NPI:1558928069
Name:MORRIS, LAPORSCHE T
Entity Type:Individual
Prefix:
First Name:LAPORSCHE
Middle Name:T
Last Name:MORRIS
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 1:1053 SE 39TH TER
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-3803
Mailing Address - Country:US
Mailing Address - Phone:561-876-4121
Mailing Address - Fax:
Practice Address - Street 1:3749 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-2147
Practice Address - Country:US
Practice Address - Phone:561-876-4121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7678951248Medicaid