Provider Demographics
NPI:1265909998
Name:MORALES, JORGE LUIS (CRNA)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:MORALES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 NW 111TH PL APT 8
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-3788
Mailing Address - Country:US
Mailing Address - Phone:786-259-2906
Mailing Address - Fax:
Practice Address - Street 1:1100 NW 95TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2038
Practice Address - Country:US
Practice Address - Phone:305-694-3640
Practice Address - Fax:305-694-4810
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9287515367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered