Healthcare Provider Details

I. General information

NPI: 1851509707
Provider Name (Legal Business Name): DAISY MORA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

IV. Provider business mailing address

12751 SW 147TH ST
MIAMI FL
33186-6302
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-8279
  • Fax:
Mailing address:
  • Phone: 786-242-5382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP 2572612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: