Healthcare Provider Details

I. General information

NPI: 1477446474
Provider Name (Legal Business Name): DAVID MORALES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/31/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 12TH AVE NE
NAPLES FL
34120-3446
US

IV. Provider business mailing address

1062 12TH AVE NE
NAPLES FL
34120-3446
US

V. Phone/Fax

Practice location:
  • Phone: 786-262-3907
  • Fax:
Mailing address:
  • Phone: 786-262-3907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number9544744
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: