Healthcare Provider Details

I. General information

NPI: 1255211835
Provider Name (Legal Business Name): JOHANNA MARIE MORASCALLO DAQUIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 ISLAND PL E
MEMPHIS TN
38103-9035
US

IV. Provider business mailing address

1428 ISLAND PL E
MEMPHIS TN
38103-9035
US

V. Phone/Fax

Practice location:
  • Phone: 662-202-2181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number244735
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: