Healthcare Provider Details

I. General information

NPI: 1497430144
Provider Name (Legal Business Name): MORGAN WILLOUGHBY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 LAKELAND HILLS BLVD STE A
LAKELAND FL
33805-4543
US

IV. Provider business mailing address

309 W PALM DR
LAKELAND FL
33803-7210
US

V. Phone/Fax

Practice location:
  • Phone: 407-650-7715
  • Fax:
Mailing address:
  • Phone: 502-767-8102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberPA9117568
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: