Provider Demographics
NPI:1629650767
Name:MORALES, NINA (PA-C)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E PRINCETON ST STE 310
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1468
Mailing Address - Country:US
Mailing Address - Phone:407-303-5781
Mailing Address - Fax:407-303-5794
Practice Address - Street 1:615 E PRINCETON ST STE 310
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1468
Practice Address - Country:US
Practice Address - Phone:407-303-5781
Practice Address - Fax:407-303-5794
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X, 363AS0400X
FLPA9114333363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical