Provider Demographics
NPI:1245932839
Name:MORALES, FERNANDO JORGE (FNP)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:JORGE
Last Name:MORALES
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 SW 22ND CT
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-1351
Mailing Address - Country:US
Mailing Address - Phone:786-474-1665
Mailing Address - Fax:
Practice Address - Street 1:239 SW 22ND CT
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-1351
Practice Address - Country:US
Practice Address - Phone:786-474-1665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11021833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily