MEDICARE: MS. HANNAH NICOLE MORALES

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
1	2255A2300X	Athletic Trainer	2000035280

General Provider Information

NPI Number	:	1568935906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HANNAH NICOLE MORALES

Provider Business Mailing Address
First Line	:	110 BARRACUDA ST
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-5002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2221 S DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-6313
Country	:	US
Telephone Number	:	813-497-5059
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2019
Last Update Date	:	08/02/2021

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