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NPI Code Detail

MEDICARE: MRS. THERESA ELIZABETH MORIN

MEDICARE: MRS. THERESA ELIZABETH MORIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner95111057FL

General Provider Information

NPI Number : 1093432155
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. THERESA ELIZABETH MORIN
Provider Business Mailing Address
First Line : 705 WELLS RD STE 300
Second Line :
City : ORANGE PARK
State : FL
Zip : 32073-2982
Country : US
Telephone Number : 904-282-6331
Fax Number :
Provider Business Practice Location Address
First Line : 8262 POINT MEADOWS DR
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-4700
Country : US
Telephone Number : 904-904-2654
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2022
Last Update Date : 11/02/2022

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