Provider Demographics
NPI:1720507908
Name:MORALES MONTES DE OCA, JORGE LUIS (APRN)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:MORALES MONTES DE OCA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3028
Mailing Address - Country:US
Mailing Address - Phone:786-583-4393
Mailing Address - Fax:
Practice Address - Street 1:3351 EXECUTIVE WAY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-3935
Practice Address - Country:US
Practice Address - Phone:855-441-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008784363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily