Healthcare Provider Details

I. General information

NPI: 1457828477
Provider Name (Legal Business Name): ELISE MORALES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 SW 87TH AVE STE 10
MIAMI FL
33173-5426
US

IV. Provider business mailing address

18445 SW 136TH AVE
MIAMI FL
33177-6258
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-9511
  • Fax: 305-271-0383
Mailing address:
  • Phone: 305-710-0622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11000767
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: