Provider Demographics
NPI:1982975512
Name:WINOKUR, MORGAN RAQUEL (PAC)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:RAQUEL
Last Name:WINOKUR
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N FEDERAL HWY
Mailing Address - Street 2:#354
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2400
Mailing Address - Country:US
Mailing Address - Phone:800-488-0279
Mailing Address - Fax:866-902-8817
Practice Address - Street 1:1001 N FEDERAL HWY
Practice Address - Street 2:#354
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2400
Practice Address - Country:US
Practice Address - Phone:800-488-0279
Practice Address - Fax:866-902-8817
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4947363AS0400X
FL9107851363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ672044Medicaid
AZ151409Medicare PIN