Healthcare Provider Details

I. General information

NPI: 1689562290
Provider Name (Legal Business Name): PERLA RUIZ MORFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 WATERMAN WAY STE 1290
TAVARES FL
32778-5250
US

IV. Provider business mailing address

770 W GRANADA BLVD STE 101
ORMOND BEACH FL
32174-5179
US

V. Phone/Fax

Practice location:
  • Phone: 352-742-0054
  • Fax: 352-742-4814
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11040593
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: