Provider Demographics
NPI:1811569064
Name:MORALES LOPEZ, JOSE MANUEL (ARNP)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:MANUEL
Last Name:MORALES LOPEZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6821 SOUTHPOINT DR N STE 107
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8026
Mailing Address - Country:US
Mailing Address - Phone:866-372-0308
Mailing Address - Fax:877-460-4651
Practice Address - Street 1:6607 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3985
Practice Address - Country:US
Practice Address - Phone:813-499-1500
Practice Address - Fax:813-499-1499
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11014288363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily