Healthcare Provider Details

I. General information

NPI: 1043238132
Provider Name (Legal Business Name): MARIA ELANA MORA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 BRANSCOMB RD STE 3
GREEN COVE SPRINGS FL
32043-7222
US

IV. Provider business mailing address

91 BRANSCOMB RD STE 3
GREEN COVE SPRINGS FL
32043-7222
US

V. Phone/Fax

Practice location:
  • Phone: 904-861-1034
  • Fax: 904-861-1037
Mailing address:
  • Phone: 904-861-1034
  • Fax: 904-861-1037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0065318
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: