=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457828477
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELISE MORALES CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2018
-----------------------------------------------------
Last Update Date | 04/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7500 SW 87TH AVE STE 10
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-5426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-595-9511
-----------------------------------------------------
Fax | 305-271-0383
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18445 SW 136TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33177-6258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-710-0622
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | APRN11000767
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------