Healthcare Provider Details

I. General information

NPI: 1124224472
Provider Name (Legal Business Name): JESSICA ANGELA MORLOK-PRINCE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2423
US

IV. Provider business mailing address

307 BLOSSOM LN
PALM BEACH SHORES FL
33404-5708
US

V. Phone/Fax

Practice location:
  • Phone: 305-661-1515
  • Fax:
Mailing address:
  • Phone: 561-494-2804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 99016
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberME99016
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: