Provider Demographics
NPI:1629774229
Name:MORALES, TANIA G (APRN)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:G
Last Name:MORALES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 PINE NEEDLES CIR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1128
Mailing Address - Country:US
Mailing Address - Phone:407-454-3634
Mailing Address - Fax:
Practice Address - Street 1:108 PINE NEEDLES CIR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1128
Practice Address - Country:US
Practice Address - Phone:407-454-3634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11024320363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11024320OtherAPRN LICENSE